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Friedrich G. Wallner
ISBN 978-3-88309-948-4
46
Fengli Lan and Friedrich G. Wallner (eds.)
The Concepts of Health and Disease libri nigri 46
In manchen Disziplinen, oder sogar in den meisten, würden Sie sofort Probleme bekommen, wenn Sie bestimmte Autoren zitieren. Man würde dann sagen: „Der gehört nicht zu uns, der versteht nichts vom Fach.“
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Max Planck
Lan/Wallner - The Concepts of Health and Disease
Eine neue wissenschaftliche Wahrheit pflegt sich nicht in der Weise durchzusetzen, daß ihre Gegner überzeugt werden und sich als belehrt erklären, sondern vielmehr dadurch, daß die Gegner allmählich aussterben und daß die heranwachsende Generation von vornherein mit der Wahrheit vertraut gemacht ist.
Verlag Traugott Bautz GmbH The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
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Fengli Lan and Friedrich G. Wallner (eds.) The Concepts of Health and Disease
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
LIBRI NIGRI
46
Edited by
Hans Rainer Sepp
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Editorial Board Suzi Adams · Adelaide │ Babette Babich · New York │ Kimberly Baltzer-Jaray · Waterloo, Ontario │ Damir Barbarić · Zagreb │ Marcus Brainard · London │ Martin Cajthaml · Olomouc │ Mauro Carbone · Lyon │ Chan Fai Cheung · Hong Kong │ Cristian Ciocan · Bucureşti │ Ion Copoeru · Cluj-Napoca │ Renato Cristin · Trieste │ Riccardo Dottori · Roma │ Eddo Evink · Groningen │ Matthias Flatscher · Wien │ Dimitri Ginev · Sofia │ Jean-Christophe Goddard · Toulouse │ Andrzej Gniazdowski · Warszawa │ Ludger Hagedorn · Wien │ Terri J. Hennings · Freiburg │ Seongha Hong · Jeollabukdo │ Edmundo Johnson · Santiago de Chile │ René Kaufmann · Dresden │ Vakhtang Kebuladze · Kyjiw │ Dean Komel · Ljubljana │ Pavlos Kontos · Patras │ Kwok-ying Lau · Hong Kong │ Mette Lebech · Maynooth │ Nam-In Lee · Seoul │ Monika Małek · Wrocław │ Balázs Mezei · Budapest │ Viktor Molchanov · Moskwa │ Liangkang Ni · Guanghzou │ Cathrin Nielsen · Frankfurt am Main │ Ashraf Noor · Jerusalem │ Karel Novotný · Praha │ Luis Román Rabanaque · Buenos Aires │ Gian Maria Raimondi · Pisa │ Rosemary Rizo-Patrón de Lerner · Lima │ Kiyoshi Sakai · Tokyo │ Javier San Martín · Madrid │ Alexander Schnell · Paris │ Marcia Schuback · Stockholm │ Agustín Serrano de Haro · Madrid │ Tatiana Shchyttsova · Vilnius │ Olga Shparaga · Minsk │ Michael Staudigl · Wien │ Georg Stenger · Wien │ Silvia Stoller · Wien │ Ananta Sukla · Cuttack │ Toru Tani · Kyoto │ Detlef Thiel · Wiesbaden │ Lubica Ucnik · Perth │ Pol Vandevelde · Milwaukee │ Chung-chi Yu · Kaohsiung │ Antonio Zirion · México City – Morelia.
The libri nigri series will be edited at the Central-European Institute of Philosophy, Prague. www.sif-praha.cz
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
The Concepts of Health and Disease From the Viewpoint of four Cultures
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Edited by Fengli Lan and Friedrich G. Wallner
Verlag Traugott Bautz GmbH The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Bibliografische Information der Deutschen Nationalbibliothek
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Die deutsche Bibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie. Detaillierte bibliografische Daten sind im Internet abrufbar über http://dnb.ddb.de
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ISBN 978-3-88309-948-4
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
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In Loving Memory of Rosmarie
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
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Table of Contents
Preface ····························································································································· 10
Chapter 1 Analysis of and on Chinese Medicine Fengli Lan (Shanghai University of Traditional Chinese Medicine) Friedrich G. Wallner (University of Vienna) Triple Jiao: Having a Name but No Shape? ···························································· 13
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Fengli Lan (Shanghai University of Traditional Chinese Medicine) Friedrich G. Wallner (University of Vienna) Transmitting Trend of Chinese Medicine in the West: From Skills to Way ··································································································· 27 Zhang Lishan (Dongzhimen Hospital, Beijing University of Chinese Medicine) The Whole – the Starting Point of Understanding Disease in TCM ···················· 55 Susanne Hiekel (Universität Duisburg-Essen, Institut für Philosophie) Traditionelle Chinesische Medizin – Ein paralleles Forschungsprogramm ········································································ 65
Chapter 2 European Reflections on Problems of Health and Medicine Nicole Holzenthal (University of Oviedo, Intersophia – International Network of Philosophical Studies) Culture and Medicine in the Philosophical Materialism and Constructive Realism ························································································· 91
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
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Table of Contents
Andreas Schulz (University of Vienna) How can different medical systems be true at the same time? Popper, Feyerabend and Wallner about truth and method ·································· 119 José A. López Cerezo (Universidad de Oviedo) North by Northwest: The Seach for Objectivity in the Origins of Modern Western Medicine ················································································ 133 Konstantin S. Khroutski (Veliky Novgorod, Russia, Novgorod State University after Yaroslav-the-Wise) What can neo-Aristotelian ideas contribute to establish an Integrative medicine? ··························································································153 Gerhard Klünger (University of Vienna) Anthroposophic medicine (AM) A short introduction into basic concepts ······························································ 189
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Hisaki Hashi (University of Vienna) Dr. Morita’s Psychophysical Therapy Influenced by Zen Buddhism – A Comparison of the Thinking Principles of Morita and the Cognitive Scientist M. Schlick ········································································· 227
Chapter 3 The Special Situation of Psychotherapy Kurt Greiner (Sigmund Freud University) Gabriela Breindl (Sigmund Freud University) Tools of Experimental Hermeneutics in Psychotherapy Science ························ 241
Chapter 4 The Buddhist Perspective Sumalee Mahanarongchai (Bangkok, Thailand, Thammasat University) The Wheel of Life and Buddhist Understanding of Health ································· 265
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
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Table of Contents
Pataraporn Sirikanchana (Bangkok, Thailand, Thammasat University) Thai Buddhism on Health ······················································································ 283 Anchalee Chaiyasuj (Thailand, Ministry of Public Health) Thai Traditional Medicine in Thailand Health System ········································· 293
Chapter 5 Aspects of Health from the Viewpoint of Islamic Culture and Philosophy
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Mohammad Khodayarifard (Iran, University of Tehran) Gholam Ali Afrooz (Iran, University of Tehran) Sayyed Mohsen Fatemi (The University of British Columbia) Yasamin Abedini (University of Isfahan) Spiritual-Religious Family Therapy: History, Theoretical and Experimental Bases and its Techniques and Principles ·········································································· 311 Saeid Zarghami-Hamrah (Kharazmi University) Mental health in intellectual/peripatetic attitude in Islamic philosophy with an emphasis on ideas by Ibn Miskawayh: Strangification of the doctrine of the mean? ························································· 333
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Preface This book offers the highlights of the conference: Concepts of Health and Disease from the Viewpoint of Four Cultures. The selected 16 papers are divided into five chapters according to their topics: Chapter 1: Analysis of and on Chinese Medicine, Chapter 2: European Reflections on Problems of Health and Medicine, Chapter 3: The Special Situation of Psychotherapy, Chapter 4: The Buddhist Perspective, and Chapter 5: Aspects of Health from the Viewpoint of Islamic Culture and Philosophy. We start with the research on Chinese medicine. The first two contributions analyze fundamental concepts of Chinese medicine in linguistic and philosophical methodology. In the third paper a practitioner tries to develop the structure of Chinese medicine from a fundamental concept. On the end of this chapter, a philosopher discusses the structure of Chinese medicine from the viewpoint of philosophy of science and offers ideas for the decision between Western medicine and Chinese medicine. The first two papers of the chapter 2 discuss medical systems under the aspect of Constructive Realism and philosophical materialism. The third paper points out a central idea of Western philosophy in respect to medicine. The other three papers discuss different problems arising from European culture: New Aristotelian ideas, Anthroposophic medicine, and psychophysical therapy – a comparison between Buddhist and Western ideas. In the Chapter 3, on the basis of Constructive Realism the author tries to develop psychotherapy science. The first paper of Chapter 4 shows by detailed analysis of texts how Buddhist thinking and understanding of health are interwoven. The second paper summarizes the Buddhist concept of health under the special observation of Thai Buddhism. The last one offers an overview on Thai traditional medicine. Chapter 5 analyses aspects of health from the viewpoint of Islamic culture and philosophy. The first develops a concept and a procedure of family therapy in the history of theory and practice under the guidance of religion. The other one discusses the concept of mental health in Islamic Philosophy by the use of the methodology of Strangification. September 2014 Fengli LAN and Friedrich G. WALLNER
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Chapter 1
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Analysis of and on Chinese Medicine
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
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Triple Jiao: Having a Name but No Shape?
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Fengli Lan (Shanghai University of Traditional Chinese Medicine) Friedrich G. Wallner (University of Vienna)
Triple Jiao, the collective term for the upper, middle, and lower Jiao, is the sixth fu organ, a specific and unique organ in Chinese medicine. It stands interior-exterior relationship with the pericardium through the homing and netting connections of the meridians of the two organs. The twenty-fifth difficult issue” and “The thirty-eighth difficult issue of Nan Jing or The Classic of Difficult Issues 《难经》 proposes that Triple Jiao “has a name but no shape”, which evoked disagreement on its physical shape, location, and meaning among physicians of the later generations. And, as a consequence, its English translation is very confusing. But its main physiological functions, understanding it as specific body areas and a concept of pattern identification for warm diseases have got to a common view.
1
Common Views of “Tripe Jiao”
Main physiological functions: Governing all kinds of qi and functioning as the waterways are considered as Triple Jiao’s major functions. That is to say, Triple Jiao functions to process fluids by the transformative action of qi and to ensure the free flow through the waterways, which is played coordinately by the lungs, spleen, kidneys, stomach, small intestine, large intestine, and bladder in the body’s water metabolism and qi metabolism. As Basic Questions · Discourse on Hidden Canons in the Numinous Orchid Chambers《素问·灵兰秘典论》states that “Triple Jiao holds the office of the sluices; and the waterways originate from it.” Triple Jiao as specific body areas: Triple Jiao is divided as three segments referred to as the upper, middle, and lower Jiao. The upper Jiao refers to the chest
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Fengli Lan and Friedrich G. Wallner
above the diaphragm, and includes the head, heart and lungs; and it is mainly responsible for the qi metabolism. The middle Jiao refers to the upper abdomen, the part below the diaphragm and above the umbilicus, and includes the spleen, stomach, liver, and gallbladder; and it is mainly responsible for the food digestion. The lower Jiao refers to the organs and the part below the stomach, and includes the small intestine, large intestine, kidneys, and bladder; and it is mainly responsible for the discharge of the waste. Triple Jiao as a concept of pattern identification for warm diseases: Triple Jiao Pattern Identification was proposed by Wu Jutong 吴鞠通（1758-1836）to diagnose warm diseases. It is used to explain the onset, development, and transmission of warm diseases: from the upper to the lower, from the exterior to the interior. Diseases of the upper Jiao involve the lungs and pericardium, usually representing the initial stage of a disease; Diseases of the middle Jiao involve the stomach, large intestine, and spleen, representing the intermediate or extreme stage of a disease; Diseases of the lower Jiao involve the liver and kidneys, representing the last stage of a disease.
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2
What the “Tripe Jiao” Exactly Refers to?
Triple Jiao first appeared in “Basic Questions · Discourse on the True Words in the Golden Cabinet”《素问·金匮真言论》, which reads that “As regards to yin and yang of the zang-fu or depots and palaces, zang or depots are yin while fu or palaces are yang. Thus the liver, heart, spleen, lungs, and kidneys are yin while the gallbladder, stomach, large intestine, small intestine, bladder, and triple Jiao are yang.” But, its shape and location are not shown in this quotation.
2.1 Explanations of the “Tripe Jiao” from Different Schools What does “triple jiao” really mean and what is the term explanation of it? Physicians over the ages hold different views of “triple jiao”, some explain it with physical forms, while others explain it by its functions. Prof. Ren Yingqiu 任应秋 (1914-1984) in Theories of Schools of Chinese Medicine 《 中 医 各 家 学 说 》 summarized the explanations of “triple jiao” from physicians over the ages from Three Kingdoms (220-265) and Jin dynasty (265-420) to People’s Republic of China (1949 - ) in five categories: 14
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
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Triple Jiao: Having a Name but No Shape?
The first school holds that the “triple jiao” has no shape, represented by Sun Yikui（孙一奎，1522-1619）. In his viewpoint, “triple jiao” has its meridian but has no fu or palace, and it is the function of the bladder and the sea of qi of the chest center (Dan Zhong, 膻中); and so it has a name but no shape. The second school regards the “triple jiao” as a cavity, represented by Yu Tuan (虞抟, 1438-1517) and Zhang Jiebin (张介宾, 1563-1640). For example, Zhang Jiebin held that the “triple jiao” is one of the six fu or palaces, residing “outside the zang-fu or depots and palaces but inside the body, embracing all the zang or depots, and being the largest fu or palace like a cavity.” The third school takes the stomach as the “triple jiao”, represented by Luo Mei [罗美, dates unknown, a famous doctor in Kangxi’s Reign (1661-1722) of the Qing Dynasty (1644-1911)]. In his viewpoint, the "triple jiao" is the division for the stomach – “Therefore, we know that triple Jiao is the division for the stomach according to itsupper and lower rough outlines. The location of the triple Jiao is the same as that of Yangming or Yang Brightness (i. e. stomach). What the triple Jiao governs is just what the Yangming or Yang Brightness (i. e. stomach) gives.” The fourth school takes the “triple jiao” as a fat membrane, represented by Tang Rongchuan (唐容川, 1846-1897). In his viewpoint, the sinogram 1 焦 (“jiao”) is interchangeable with 膲 (“jiao”), and 膲（“jiao”) is an internal fleshy organ. That is to say, the membrane of the body is the “triple jiao”. He said, “Triple Jiao is the membrane of the body, connecting the stomach, intestines with the bladder”, “linking banyou or the leaf fat with jiguanyou or the cockscomb fat, attaching to the small intestine, and stretching out to become interstices of the lumbar and abdomen.” The fifth school regards the “triple jiao” as three sections of the body, represented by Yang Xuancao [杨玄操, dates unknown, a doctor in Tang Dynasty (618-907)] and Li Gao (李杲, 1180-1251). In this viewpoint, the “triple jiao” is explained as the upper, middle and lower sections of the body - Heart and lung disease can be called “the upper Jiao disease”; Spleen and stomach disease are named “the middle Jiao disease”; Parturition, menstrual disorders and abnormal 1
For translation of Chinese 汉字 We prefer “sinogram” instead of “Chinese character”, which was originally proposed by Prof. Pan Wenguo 潘文国 (1944- ) in his monograph entitled “Sinogram as the Basic Unit and Chinese Language Study” 《字本位与汉语研究》 published in 2002. The author advanced that Chinese language study should take Zi or sinogram instead of Ci or word as the basic unit for Chinese language study.
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vaginal discharge, impotence and sterility as well as weakness and aching of the lumbar and the legs are considered as “the lower Jiao disease”. The statement that the triple Jiao has a shape was first proposed by Chen Wuze（陈无择, 1131-1189）in his monograph entitled A Unified Treatise on Diseases, Symptoms, and Remedies According to the Three Causes”《三因极一病证 方论》. He held that the triple Jiao is a piece of membrane: “Triple Jiao is a fat membrane as large as a hand, just being the opposite of the bladder.” Pang Jinyi 庞近宜 put forward that the “triple jiao” is the “triple vertebra”. He believed that Feishu 肺俞 (BL-13)is located [at 1.5 cun lateral to the spinal process of] the Third Jiao 焦 or Vertebra, Xinshu 心俞(BL-15) is located [at 1.5 cun lateral to the spinal process of] the Fifth Jiao 焦 or Vertebra, and Geshu 膈俞 (BL-17) is located [at 1.5 cun lateral to the spinal process of] the Seventh Jiao 焦 or Vertebra(See “The Miraculous Pivot · The Back Transport Points”《灵枢·背俞》). Here, it is obvious that “焦 jiao” is a loan sinogram of “椎 zhui”, and the “triple jiao” here refers to the three thoracic vertebrae, and has nothing to do with the shape, name, and meaning of the “triple jiao” in the common sense. Qian Bingqiang 钱秉强 simulated a method of archaeology prevailing in the world today and figured out that the original meaning of “triple jiao” referred to the portal vein-oriented veins in thoracic and abdominal cavity through animal-dissecting tests. Referring to the physiological knowledge of Western medicine, most of modern scholars seek for anatomical organs, tissues or systems corresponding to the “triple jiao” according to its functions, such as the Lymphatic system hypothesis proposed by Zhang Taiyan (章太炎, 1869-1936), Lu Yuanlei（陆渊雷, 1894-1955）and the research team for Chinese and Western Medicine of the Jiangyin Health Bureau, Jiangsu Province, pancreas hypothesis by Zhao Dihua 赵棣华 and the hypothesis of the body fluid equilibrium system by Xia Han 夏涵, etc. The proposed organ, tissue or system may explain some of the functions of the “triple jiao”. For example, liquid and humor metabolism explains its role in regulating the waterways but leaves out its qi transforming function – “Governing all kinds of qi”, which is also impossible to cover that the “triple jiao” is divisible but inseparable with all the other zang-fu or depots and palaces. Therefore, many scholars point out that the “triple jiao” is reasoned, concluded and analyzed to be a theory of a combination of intuition and reasoning based on clinical symptoms, physiological phenomena and observation of exposed corpses. Regardless of the differences between the Chinese and Western medical systems, 16
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Triple Jiao: Having a Name but No Shape?
the farfetched equation of “triple jiao” with certain organs, tissues or systems perceived by Western medicine would inevitably lead to controversies and disagreements. Such understanding is very insightful. Such easy equations and comparisons are wrong from the beginning when concerning the great differences in cultural backgrounds, philosophical foundations (such as epistemology, methodology), and theoretical systems between Chinese and Western medicine. “Triple jiao”, in essence, is the place and passage for generation and transformation of essence, qi, and body fluid. It is not like the other zang-fu or depots and palaces, but the others cannot independently perform their biochemical activities without it; it is not like the other tissues but they have its presence, otherwise the body's basic biochemical activities can not commence. Such “external fu or palace” or “solitary fu or palace” can only be explored through multi-system, multi-tissue and multi-level connections. It has the implication of a functional “unit”, but is not a fictitious non-existent abstraction. As one of the six fu or palaces, “triple jiao” certainly has its material basis. The “形 xing” in the statement of Nan Jing or The Classic of Difficult Issues that “The triple jiao has a name but no xing” means “xing zhuang 形状 or shape”, not “xing zhi 形质 or material basis”, which implies that “triple jiao” has its name but does not bear a certain shape. A Japanese scholar 玄医 held that “The gathering of the space among the flesh and blood, among the zang and fu or the depots and palaces is the triple jiao”. Triple Jiao connects the upper and reaches the lower, covers and includes the interior and the exterior, distributes essential qi and fluid to the whole body, and penetrates into the zang-fu or the depots and palaces, meridians, organs and tissues. Thereby, some scholars support that such understanding is the true meaning of the triple jiao (Wang Hongtu, 1997: 197, 1046-1049).
2.2 Understandingthe “Tripe Jiao” Based on Etymology of the Sinogram “Jiao” There are three versions of interpreting the sinogram “jiao”: (1) The sinogram “焦 Jiao” follows fire, is interchangeable with “燋 jiao” which means roast with fire. This implies that the triple Jiao plays a role in digesting and decomposing water and grain. (2) The sinogram“焦 Jiao” is interchangeable with “膲 jiao”, which is believed to be one of the fleshy organs of the body, such as the membrane. The Miraculous Pivot · Dew of the Year 《黄帝内经灵枢·岁露》states that “毛发残，
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膲理薄，烟垢落。”, which can be translated into “One will lose his/her hair of the body and head, his/her texture of the muscles will be sparse, and the sebum will exfoliate to be like smoky dust.” Zhang Zhicong (张志聪, 1616-1774) annotated that “The sinogram 理 li refers to the texture of the muscles, the place which the triple jiao communicates and meets. That’s why it is named 膲理 jiaoli.” (Wang Xiaolong, 2001：507). The Miraculous Pivot · On Great Confusion《黄帝内经灵枢·大惑论》states that： “邪气留于上膲，上膲闭而不通。”, which can be translated into: “Evil qi congests the upper jiao, leading to the obstruction of the upper jiao.” (3) The Five Methods of Integrating Chinese Medicine with Western Medicine 《医学汇通五种》by Tang Rongchuan (唐容川, 1846-1897) holds that “焦 jiao” was written as “ jiao” in ancient times; that the sinogram “ jiao” follows “采 cai” which means “strata or layer scan be identified”, follows “韋 (韦)wei” which means hides of cattle because the triple jiao looks like it, and follows “焦 jiao” because it (the triple jiao) has wrinkles like the skin burnt by fire; and that parts of the sinogram “采 cai” and“韋 (韦) wei” are omitted, leaving only “焦 jiao” which is not correctly understood by later generations. We can find the sinogram but cannot find the sinogram in The Origin of Chinese Characters or Shuo Wen Jie Zi 《说文解字》. Tang Rongchuan probably because the seal scripts of “米 mi” and “采 cai” mistook with were so similar to each other. The sinogram “ ” refers to something contracting because “ ” follows “米 mi” and pronounced as “焦 jiao”, originally means collecting grains by gathering and contracting. Accordingly we can see that “ ” is a soft leather-like constricted substance contracting from “all sides” to the central. In the human body, it is a membranous organ wrapping the zang-fu or the depots and palaces, and is one of the six fu or palaces. It is widely distributed in the body cavity with variable shape and closely linked with the wrapped internal organs (the zang-fu or the depots and palaces), so the generations fail to recognize its shape (Wang Hongtu,1997：197). We believe that the concept formation of the “triple jiao” is certainly based on some anatomical knowledge and has a certain material basis. The second and third explanations of “焦 jiao”in ancient medical classics are quite reasonable.
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Triple Jiao: Having a Name but No Shape?
3
English translation of “San Jiao”
The “Standard Acupuncture Nomenclature (Part 1 and 2)” approved and issued by the World Health Organization in 1991 recommends “triple energizer” as the standardized English translation of “三焦 San Jiao”. However, a considerable number of authors and translators, especially Western scholars, refuse to use this term. Among them, some use the pinyin transliteration “san jiao”, some use “triple burner”, and some use “triple warmer” or “triple heater”. The English translations of “上焦 shang jiao”、“中焦 zhong jiao”、“下焦 xia jiao” all depend on the translation of “焦 jiao”. Now, let us take a look at the English translation of “三焦” in the “Chinese-English Corpus of Chinese Medical Classics”[1], as shown in Table 1.
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Table 1 English translation of “三焦”in the “C-E Corpus of Chinese Medical Classics” TRANSLATIONS (TRANSLATORS)
CORPUS FREQ.
MAIN COLLOCATES (L1) & CORPUS FREQ.
JIAO
273
Upper 18; middle 19; lower 11; san 3
SANJIAO (Li Zhaoguo； Ni Maoshing)
101
/
ENERGIZER (Li Zhaoguo)
155
Triple 89; Upper 26; middle 18; lower 21
BURNER (Yang Shou-zhong; Unschuld P.U.; Wiseman N.; Flaws B.)
630
triple 394; upper 84; middle 43; central 22; center 4; lower 78
WARMER (Yang Shouzhong; Wu Lian-sheng, Wu Qi；Ruan Jiyuan, Zhang Guangji)
182
Triple 62; upper 34; middle 53; lower 29
HEATER (Yang Shouzhong; JingNuan; Hoc Huynh)
122
Triple 49; upper 21; middle 18; lower 27; three 4
Wu Ku
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It can be seen from the above table that, except Li Zhaoguo, all the other translators of Chinese medical classics don’t use the standardized term “triple energizer” recommended by the World Health Organization to express “三焦”. “Triple burner” is of the highest frequency in the Corpus, much higher than the other translations. The Introduction of “WHO International Standard Terminologies on Traditional Medicine in the Pacific Region” (Why the word “Terminology” is used here in plural form?) issued in 2007 explains the principles of the English translation of the nomenclature, which are as follows: Accurate reflection of the original concept of Chinese terms; No creation of new English words; Avoidance of Pinyin (Romanized Chinese) use; Consistency with WHO’s Standard Acupuncture Nomenclature (WHO, 2007: 4). Obviously, the World Health Organization can not follow the four principles simultaneously when selecting the standardized translation of “三焦”, but it makes appropriate adjustments based on the current use of the translation. It uses “triple energizers” as the standardized translation of “三焦”, which is consistent with the “Standard Acupuncture Nomenclature”（1991）, and in the following “Definition/Description” also mentions “triple burners”: “ triple burners：a collective term for the three portions of the body cavity, through which the visceral qi is transformed, also widely known as triple burners”(WHO, 2007: 23).What is puzzling is that why “energizers” and “burners” are in plural form behind “triple” in the nomenclature approved and issued by World Health Organization? It can be seen from “Chinese-English Corpus of Chinese Medical Classics” that some translators also give their explanations when using Pinyin transliteration to translate “焦”or“三焦”, such as Jiao (cavity), Jiao (viscera cavity), Sanjiao (the three visceral cavities responsible for fluid metabolism), Sanjiao (Three Portions of Body Cavity), etc. From here we see that the understandings of “焦” from translators of Chinese medical classics tend to be the same that is “body cavities or visceral cavities”. According to the term explanation of “三焦” in the former parts of the paper, the current English translations of “三焦” all fail to accurately reflect the meanings of the term. “Triple energizer” puts particular emphasis on San Jiao’s function of “governing all kinds of qi” as qi is usually regarded as a kind of “energy”. The translation “Triple burner” results from the misunderstanding of “焦”, just as what Prof Xie Zhufan (谢竹藩, 1924- ) said that “As a common word, this character（焦）does mean “burnt” or “charred”, but as a medical term, it means ‘passage or space within the body.’ This definition is well explained in some spe20
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Triple Jiao: Having a Name but No Shape?
cialized Chinese dictionaries like Concise Dictionary of Characters in Chinese Medicine《简明中医字典》published by Guizhou People’s Publishing House in 1985（Xie Zhufan，2003：41）.” Translations like “triple burner”, “triple warmer” and “triple heater” are all related to heat or fire, reflecting translators’ understanding of “焦 jiao”: following fire, being interchangeable with “燋 jiao”, thus meaning roast with fire, which implies that the triple Jiao plays a role in digesting and decomposing water and grain. We are very doubtful about one of the translation principles proposed by the World Health Organization – “Avoidance of Pinyin (Romanized Chinese) use”. Transliteration has been used in the translation practice for over one thousand years. Xuan Zang (玄奘, 602-664), a famous translator of Buddhist scriptures of the Tang Dynasty (618-907), systematically summed up five principles for applying transliteration in the Preface of Fanyi Mingyi Ji 《翻译名义集·序》, namely “Five reasons for no translation”: (1) “For secrets”: Sutra passphrase should be transliterated; (2) “For polysemies”: Polysemies in the Buddhist scriptures should be transliterated; (3) “For concepts without equivalents in the target language”: Concepts without equivalents in the target language (Chinese) should be transliterated; (4) “For following ancient transliteration”: The ancient transliteration established by the people through long practice should be kept in use; (5) “For respecting the original work, e.g., the transliteration “般若 bō rě” for a concept in Buddhist scriptures shows respect to the original while its translation “wisdom” sounds unimportant and superficial. Using transliteration to avoid losing the true meaning of the original. Such principles are of great significance to keep the original meaning and effect, to fill semantic vacancies caused by cultural and linguistic differences and to introduce foreign words (Chen Hongwei, 1998: 7). The practice of translating Chinese medical texts into a Western language shows that the “Five reasons for no translation (i.e. transliteration)” tally fully with the actual situation of the translation of Chinese medicine. For example, the concept “气 qi” apparently bears many meanings, no matter “energy”, “influence” or “atmosphere” is all unable to convey all its meanings, and so it should be pinyin transliterated as “qi”. Transliteration is of great significance to keep the original meaning and effect, to fill semantic vacancies caused by cultural and linguistic differences and to introduce foreign words. The practice of translating Chinese medical texts into a
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Western language shows that use of pinyin transliteration is gradually becoming more widely used. Words formed through Pinyin transliteration such as “yin”, “yang”, “qi”, “Dao (Tao)”, etc. have long been accepted by English vocabulary system. At present, the names of Chinese medicinals, formulas, acupuncture points and titles of ancient books tend to be Pinyin transliterated; and Pinyin transliterations of the above names/titles are almost completely adopted in oral international academic activities such as in classroom and clinical teaching and international academic exchanges. Based on the term explanations of “triple jiao” and its available translations, we believe that Pinyin transliteration, i.e., “san jiao” or “triple jiao”, is the best translation of “三焦” in order to avoid ambiguity and confusion.
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Note: [1] The paper is a part of the research outcome of the research project “A Corpus-Based Study on English Translation of Ancient Chinese Medical Classics” Funded by National Fund for Philosophy and Social Sciences (No. 09CYY008). Based on the interpretation of Chinese medicine in the sense of philosophy of science and a C-E corpus of ancient Chinese medical classics (Chinese Corpus composed of 13 ancient Chinese medical classics with1.485 millions of sinograms; English Corpus composed of 22 translations of 11 classics among the above-mentioned with 2.62 millions of words), the project studies the English translation of these ancient Chinese medical classics from their terminology to discourses.
Chief References A. Four Translations of Huang Di Nei Jing Su Wen《黄帝内经素问》(in the order of their published years): 1
Ni, Maoshing. The Yellow Emperor’s Classic of Medicine. Boston, Massachusetts: Shambhala, 1995. 2 Original Note by [Tang Dynasty] Wang Bing; Englished by Wu, Liansheng Nelson & Wu, Andrew Qi. Yellow Empero’s Canon Internal Medicine·Plain Questions (Chinese-English). Beijing: China Science & Technology Press, 1997.
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Triple Jiao: Having a Name but No Shape? 3
Li Zhaoguo.Yellow Emperor’s Canon of Medicine · Plain Conversation (Chinese-English) (3 Volumes). Xi’an: World Publishing Corporation, 2005. 4 Unschuld, Paul U. & Tessenow, Hermann in Collaboration with Zheng Jinsheng. HUANG DI NEI JING SU WEN: Annotated Translation of Huang Di’s Inner Classic – Basic Questions (2 Volumes). Berkeley, Los Angeles and London: University of California Press, 2011. B. Three Translations of Huang Di Nei Jing Ling Shu《黄帝内经灵枢》 ： 5
Wu Jing-Nuan. Ling Shu or The Spiritual Pivot. Hawai’i: University of Hawai’i Press, 1993. 6 Original Note by [Tang Dynasty] Wang Bing; Englished by Wu, Liansheng Nelson & Wu, Andrew Qi. Yellow Empero’s Canon Internal Medicine·Spiritual Pivot (Chinese-English). Beijing: China Science & Technology Press, 1997. 7 Li Zhaoguo. Yellow Emperor’s Canon of Medicine·Spiritual Pivot (Chinese-English) (3 Volumes). Xi’an: World Publishing Corporation, 2008. ： C. Two Translations of Nan Jing《难经》 8
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Unschuld, Paul U. Nan-Ching: The Classic of Difficult Issues. Berkeley, Los Angeles and London: University of California Press, 1986. 9 Flaws, Bob. The Classic of Difficulties. Boulder: Blue Poppy Press, 1999; 2003; 2004. ： D. Three Translations of Shang Han Lun《伤寒论》 10
Originally by Zhang Ji; Translated by Mitchell, C., Feng Ye, Wiseman, N. Shang Han Lun: On Cold Damage (Translation and Commentaries). Brookline, Massachusetts: Paradigm Publications, 1999. 11 Originally by Zhang Ji; Translated by Luo Xiwen. Library of Chinese Classics (Chinese-English). Treatise on Febrile Caused by Cold (Shang Han Lun). Beijing: New World Press, 2008. 12 Yang Jie De, Greta & Marchment, Robin. Shang Han Lun Explained. Elsevier Australia: Churchill Livingstone, 2009.
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Fengli Lan and Friedrich G. Wallner E. Four Translations of Jin Gui Yao Lue《金匮要略》 ： 13
Written by Zhang Zhongjing; Compiled and Translated by Luo Xiwen. Synopsis of Prescriptions of the Golden Chamber with 300 Cases. Beijing: New World Press, 1993. 14 Originally by Zhang Ji; Translated by Wiseman, Nigel & Wilms, Sabine. Jin Gui Yao Lue: Essential Prescriptions of the Golden Cabinet (Translation and Commentaries). Brookline, Massachusetts: Paradigm Publications, 2000; 2012; 2013. 15 Ruan Jiyuan, Zhang Guangji. Jingui Yaolue (Chinese-English). Shanghai: Shanghai Scientific & Technical Publishers, 2003. 16 Written by Zhang Zhongjing; Compiled and Translated by Luo Xiwen. Library of Chinese Classics (Chinese-English). Synopsis of Prescriptions of the Golden Chamber (Jingui Yaolue). Beijing: New World Press, 2008. F. One Translation of Shen Nong Ben Cao Jing《神农本草经》: 17
Yang Shou-Zhong. The Divine Farmer’s Materia Medica: A Translation of the Shen Nong Ben Cao (Blue Poppy’s Great Masters Series). Boulder: Blue Poppy Press, 1998. G. One Translation of Zhen Jiu Jia Yi Jing《针灸甲乙经》:
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Translated by Yang Shou-Zhong. The Systematic Classic of Acupuncture and Moxibustion: Huang-Ti Chen Chiu Chia I Ching. Boulder: Blue Poppy Press, 2004. H. One Translation of Mai Jing《脉经》: 19
Originally by Wang Shu-He; Translated by Yang Shou-Zhong. The Pulse Classic: A Translation of the Mai Jing. Boulder: Blue Poppy Press, 1997. I One Translation of Zhong Zang Jing《中藏经》: 20 Translated by Yang Shou-Zhong. Master Hua’s Classic of the Central Viscera: A Translation of the Zhong Zang Jing. Boulder: Blue Poppy Press, 1993; 1999; 2001; 2003; 2006; 2007. J. Two Translations of Bin Hu Mai Xue《濒湖脉学》： 21
Originally by Li Shi-Zhen; Translated by Flaws, Bob. The Lakeside Master’s Study of the Pulse. Boulder: Blue Poppy Press, 1998; 2002.
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Translated by Huynh Hoc Ku. Pulse Diagnosis: Translation of Pin-hu mo hsueh pai hua chieh.Brookline, Massachusetts: Paradigm Publications, 1998. K. One Translation of Yi Xue Yuan Liu Lun《医学源流论》 ： 23
Originally by Hsu Ta-ch’un. Translated by Unschuld, Paul U. Forgotten Traditions of Ancient Chinese Medicine: A Chinese View from the Eighteenth Century (The I-hsueh Yuan Liu Lun of 1957 by Hsu Ta-ch’un). Brookline, Massachusetts: Paradigm Publications, 1998. L. Others 24
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Chen Hongwei. Foundation of Chinese-English Translation 汉英翻译基础 [M]. Shanghai: Shanghai: Shanghai Foreign Language Education Press, 1998. 25 Wang Xiaolong. A Practical Dictionary for Sinograms in Chinese Medicine 实用中医字典 [Z]. Beijing: Academy Press 学苑出版社, 2001. 26 Wang Hongtu. The Study of Nei Jing (3 Volumes) [M]. Beijing: China Press of Traditional Chinese Medicine, 2004. 27 World Health Organization. WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. 2007. 28 Xie Zhufan. On the Standard Nomenclature of Traditional Chinese Medicine [M]. Beijing: Foreign Languages Press, 2003.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way Fengli Lan (Shanghai University of Traditional Chinese Medicine) Friedrich G. Wallner (University of Vienna)
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Abstract Transmitting Chinese medicine in the West began in the 17th century, originating from the real therapeutic effects of Chinese medical therapies, namely the transmission of “Skills”, such as pulse taking & reading skills, moxibustion treatment for gout, acupuncture treatment for arthritis, translation of Chinese herbal medicine (such as Ben Cao Gang Mu or The Compendium of Materia Medica 《本草纲目》) and forensic medicine (such as Xi Yuan Lu or Records for Washing Away Injustice 《洗冤录》), etc. In the 20th century “the craze for acupuncture” and “the craze for Chinese medicine” in the west are also closely related to the success of acupuncture anesthesia in the Mainland China. Chinese medicine is now spreading at an unprecedented speed, scale and depth in the West after several rises and falls in the last more than 300 years. Transmission of “Way” or its philosophical foundations, in addition to “Skills”, is also a need and choice of the era when reflecting on the advantages and disadvantages of modern science and Western Medicine. The exchange and transmission of Chinese medicine in the West started in the 17th century (Ming dynasty, 1368-1644). The earliest introductions of Chinese medicine to the West come from missionaries, who introduced their own experiences with Chinese medicine in China to the West with curiosity. Matteo Ricci (1552-1610), a celebrated Italian missionary, arrived in Macau in 1582, and then opened the prologue to the first large scaled cultural exchange between
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China and Europe in the world’s history. One of the earliest introductions of Chinese medicine to the West is from Matteo Ricci’s Reading Notes: “Medical skills and methods in China were very different from those we were accustomed to. The pulse-taking methods were the same as ours, and practitioners were quite successful in treating diseases. Generally speaking, the medicinal substances they used were very simple such as grasses, roots, stalks and the like. In fact, the Chinese art of healing was all contained in the laws and rules they observed when using the herbal substances. There were no public medical schools here in China. Everyone who wanted to be a practitioner should be taught by another one who was proficient in the way of healing. It was possible to get a degree in medicine by passing a test held by Imperial Hospitals in Nanjing and Beijing, the two capitals of the Ming Dynasty. But it was just a form, could not bring any benefit to those with it. A practitioner with a medical degree was not more authoritative nor more respected than one without the degree because anyone was allowed to practice medicine no matter he/she was good at the art of healing or not.”1
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Michel-Pierre Boym (1612-1659), a Polish missionary from Jesuit to China in the 17th century, is another pioneer who made outstanding contributions to the transmission of Chinese medicine in the West following Matteo Ricci.
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Materia Medica, Pulse Lore, Acupuncture and Moxibustion (1656-1849)
1.1 Michel-Pierre Boym’s Contributions to Transmission of Chinese Materia Medica and Pulse Lore in Europe Michel-Pierre Boym served as the chief physician of Polish king Sigismond. He paid attention to Chinese materia medica during his mission in China and wrote “Flora Sinensis” in Latin, which is actually an abridged Latin translation of “Ben Cao Gang Mu or The Compendium of Materia Medica 《本草纲目》”. It is the earliest literature on Chinese herbal medicine which was introduced to the West and was published in Vienna in 1656; in 1664 the book was translated into French and got published as well. He also compiled Clavis Medica ad Chinarum 1
Translated from Chinese. Originally by Ricci Matteo. Translated by He Gaoji, Wang Zunzhong, Li Shen. 1983: 34.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
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Doctrinam de Pulsibus, a truly comprehensive presentation of Chinese medicine, including six parts: Latin translation of “Mai Jing or The Pulse Classic” by Wang Shuhe (王叔和, 201-280), diagnosis by observing the tongue and complexion, names of 289 Chinese medicinal items, 143 pieces of wood layout and 30 pieces of copper layout of medicinal substances. The book was published in 1680 in Frankfurt, Germany (Latin). The book was renamed Specimen Medicinae Sinicae and was published in 1682 in Frankfurt in the name of Cleyer de Cassel with 68 illustrations of meridians and viscera as the appendix at the end of the book since there were enmities between the Jesuit and the Dutch East India Company (Vereenig de Oostindische Compagnie, abbreviated as VOC). Michel-Pierre Boym's name was resumed until 1686 when the original version was published. Medicus Sinensis, one of the Michel-Pierre Boym's unpublished manuscripts, may be lost. It is worth mentioning that Michel-Pierre Boym's works of introducing Chinese medicine had a far-reaching influence in Europe, parts of which were translated into French, Italian, English, etc. For example, in 1707, John Floyer (1649-1734), a British doctor, compiled and published The Physician’s Pulse-watch by combining the English version of Michel-Pierre Boym's manuscripts of Chinese pulse lore with his own papers, which is the earliest English work on pulse lore2. All in all, the works of Michel-Pierre Boym attracted the attention of western scholars and inspired them to study Chinese medicine.
1.2 Early Introduction of Acupuncture and Moxibustion to Europe by Rhyne and Busschof Chinese acupuncture and moxibustion are time-honoured therapies. Acupuncture originated from needling with healing stones while moxibustion came from cauterization or fire/heat burning. In the middle of the 17th century, acupuncture and moxibustion were introduced into Europe through Japan. Moxibustion was transmitted into Europe earlier than acupuncture. According to the authors’ study, Treatise of the Gout authored by Herman Busschof (dates unknown) and published in 1676 in London is the first English work on Chinese medicine. Busschof, a staff of the Dutch East India Company, had suffered from gout with 2
Ma Boying, Gao Xi, Hong Zhongli, 1993: 605; Li Xisuo, Chen Shangsheng, 2002: 425-426.
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the symptom of pain in feet for 14 years in Indonesia, was cured by moxibustion. Therefore he compiled a book in Dutch (1675, Amsterdam) to introduce how to treat gout with moxibustion. The book was translated into English in 1676 from Dutch (See Illustration 1)3. Busschof created the word “moxibustion” to express “ai jiu 艾灸” by combing “mugusa”, from Japanese “moe kusa”, meaning “burning herbs”, and “-bustion”, the contracted form of the Latin word “combustio”, “combustion” in English.
Illustration 1. The Frontispiece of Treatise of the Gout by Herman Busschof (1676)
In 1683, Willem Ten Rhyne (1647-1700), another staff of Dutch East India Company, who graduated from the Medical School of Leiden University in Holland, published Dissertatio de Arthritide: Mantissa Schematica: De Acupunctura. It is the first literature of systematically introducing acupuncture to Europe although it is not the first literature of mentioning acupuncture in a Western language. Willem Ten Rhyne thus became the first person to transmit acupuncture to the West. The English word “acupuncture” used today is from the Latin word
3
Wong, Chinmin K. & Fu Weikang, 1963: 28.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
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“acupunctura (acu + punctura)” he created in the book. In the book there are four charts of acupuncture points he got from Japan, of which two are the originals of China and the other two were drawn by Japanese. Rhyne introduced the names, meanings and distributions of the fourteen meridians in details. The Illustration 2 – the chart of acupuncture points is from Willem ten Rhyne’s Dissertatio de Arthritide (London: Impensis R. Chiswell, 1683; Picture source: Wellcome Library, London).
Illustration 2. Chart of Acupuncture Points from Willem Ten Rhigne’s Dissertatio de Arthritide
“Acupuncture and Moxibustion” have been in use ever since they were created in the 17th century, which are a pair of truly standardized translation in English Chinese medical terminology and are also a pair of medical subject headings of MEDLARS (Medical Literature Analysis and Retrieval System).
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1.3 Early Translations of Chinese Medical Classics in The General History of China
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In 1735, France published a big book on China -Description de l’ Empire de la Chine, which is based on reports of missionaries to China in the 17th century, known as one of the “three masterpieces”4 of European Sinology in the 18th century, the important literature and book for Europeans to understand China and its medicine. Wong, Chinmin K. in a paper entitled Investigations of Western-Language Translations of Chinese Medical Classics mentioned this book by referring that “A Geographical, Historical, Chronological, Political, and Physical Description of the Empire of China written by a Frenchman named Jean-Baptiste Du Halde was published in Paris in 1735”5. Jean-Baptiste Du Halde (1674-1743) was a missionary of Jesuit in Paris. The book attracted the attention of British publishers immediately after it was published in France and the English version was published in the following year 1736, namely Watts J. Edition. After the first printing, it was successively reprinted in 1739 and 1740 in four volumes. The Illustration 3 is the front cover of the fourth volume of its second English Watts J. Edition. From the cover we can see how lengthy its English title is: The General History of China: Containing a Geographical, Historical, Chronological, Political, and Physical Description of the Empire of China, Chinese-Tartar, Korea and Tibet. Two volumes of a complete translation were published successively in 1738 and 1742, namely Cave E. edition.
4
The other two are Jesuit Communications Set and Chinese Miscellaneous Essays. All published in France. 5 Wong, Chinmin K., 1928: 103-105.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
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Illustration 3. Front Cover of the Fourth Volume of the Second English Watts J. Edition of The General History of China
Concerning the part of Chinese medicine in The General History of China, Huang Qichen 黄启臣 proposed according to his studies that its third volume was about Chinese medicine, which introduced unique Chinese medical skills, including translation of Mai Jing or The Pulse Classic《脉经》, Mai Jue or The Pulse Lore in Rhyme《脉诀》, Bencao Gangmu or The Compendium of Materia Medica《本草纲目》, Shennong Bencao Jing or Shennong’s Classic of Materia Medica《神农本草经》, Mingyi Bielu or Records of Famous Physicians《名医必录》 (《名医别录》), Yiyao Huilu or Collection and Records of Medicine《医药汇录》 and many Chinese medical prescriptions.6 On the basis of studies on contents related to Chinese medicine in the English Cave E. edition of The General History of China, Wong, Chinmin K. held that the book contains pulse theory, medicinal substances and prescriptions, and health protection, among which Mai Jue or The Pulse Lore in Rhyme 《脉诀》 by Gao Yangsheng (高阳生, dates unkown), the earliest complete English translation of Chinese medical classic in the West, is on the pulse theory; medicinal 6
Huang Qichen, 1992: 54-62.
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substances and prescriptions refer to translation of some volumes of Bencao Gangmu or The Compendium of Materia Medica《本草纲目》by Li Shizhen (李 时珍, 1518-1593), its first English abridged version; as for health protection, the transliteration of the book title resembles Changsheng or Longevity《长生》or Zunsheng or Respecting Life《遵生》or the like, but the contents are different from each other.7 From the above we can draw a conclusion that the earliest English translation of Chinese medical classics originates from the part of Chinese medicine of the English edition of The General History of China. Since then there was a great upsurge in learning and studying Chinese medicine among Europeans, exerting a profound impact on modern medicine, zoology, botany and doctrine of evolution in the Western Europe.
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1.4 Influences of Bencao Gangmu in Europe In 1812, Jean-Pierre Abel-Rémusat (1788-1832), a French scholar, published his M.D. (Doctorate in Medicine) dissertation on Bencao Gangmu or The Compendium of Materia Medica《本草纲目》; later on, both of his books Dissertaio de Glosso-semeiotice, rive de signis morborum quae e lingua sumuntur, praesertim apud Sinenses (1813) and Recherches historiques sui la medicine des Chinois, etc (1813) did further studies and gave further introductions to Bencao Gangmu or The Compendium of Materia Medica, and thus promoting its spread in Europe. Missionaries felt incredible that Chinese herbal medicine can cure many diseases, but its effectiveness is after all a fact. So they studied Chinese herbal medicine and associated them with botany, thus promoting the further development of botany in Europe. Charles Robert Darwin (1809-1882), a great British biologist, quoted some information about the formation of colors of goldfishes from Bencao Gangmu to illustrate that animals have artificial selection problems in his book The Descent of Man. Besides, he repeatedly referred to Bencao Gangmu in the second chapter Artificial Selection of his another book The Variation of Animals and Plants under Domestication. According to the statistics, there are as much as 104 places mentioning herbal medicine and Chinese medicine in
7
Qiu Le, 2011: 459-464.
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the works by Darwin.8 This shows that Chinese medicine and Chinese herbal medicine also have a considerable impact on Darwin's doctrine of evolution.
1.5 Contributions from Other Missionaries to China
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In addition, Dominicus Parrenin (1665-1741), a French Jesuit, had also made outstanding contributions to transmitting Chinese medicine to Europe. He made a scientific appraisal about Chinese medicine that Chinese medicine is significantly effective in treating some diseases, but is not as good as Western medicine in theory, esp. the lagging behind of anatomy. This conclusion was later accepted by Voltaire (1694-1778). In his work Essai Sur Les Moeurs, he discussed Chinese medicine, “In China, medical theories still remain ignorant and wrong, but Chinese practitioners are quite successful in their practices.”9 Dominicus Parrenin also sent materials about how to treat tuberculosis with Donkey-hide gelatin (Ejiao, 阿胶) to the French Academy of Science from Macau. In the Report from Beijing Missionaries he picked up Xi Yuan Lu or Records for Washing Away Injustice《洗冤录》as the world’s first work on forensic medicine. In the fourth volume of Report from Beijing Missionaries, Pierre Martial Cibot (1727-1780) also introduced Chinese understanding of the pathology of smallpox and methods of how to treat it in China. Since then, Chinese medicine esp. medical skills became popular in Europe.
1.6 General Features of the Translations on Chinese Medicine During this period, translators were all Europeans, among which some of them were staff of Dutch East India Company and most of them were European missionaries in China. Translation contents are mostly their own experiences in Chinese medicine, or overviews of Chinese medicine, or related to acupuncture and moxibustion, or history of Chinese medicine, or herbal medicine, or pulse lore, etc. Besides, English translations of Mai Jue or The Pulse Lore in Rhyme and Bencao Gangmu or The Compendium of Materia Medica were also published and they were included in The General History of China. 8 9
Pan Jixing, 1954; 1959: 521-525. Voltaire, 1963: 398.
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As for the translation form, it involves abridged, edited and full translations; as for the translation strategy, it involves foreignization and domestication, among which foreignization reflects that early compilers or translators of English translations of Chinese medicine accepted and respected the uniqueness of Chinese culture; as for translation methods, transliterations or Chinese characters (or sinograms) were used to translate most of the culturally-loaded terms in Chinese medicine, on the basis of which literal translations, free translations and paraphrases were flexibly combined with them when Latin translations were retained in the meanwhile.
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2
Translation and Transmission of Chinese Medical Classics in Europe（1850-1950）
Places of publication of Chinese medical works in English were expanded from London, Britain to Beijing, Tianjin, Shanghai, Guangdong in China, and Baltimore, Philadelphia, in the United States, etc. During this stage, the initial stage of translating Chinese medical classics, Xi Yuan Lu or Records for Washing Away Injustice《洗冤录》 (1855, 1875-1924), Huangdi Neijing or Huangdi’s Inner Classic 《黄帝内经》(1949, 1950), Bencao Gangmu or The Compendium of Materia Medica 《本草纲目》(1871-1941), Jiuhuang Bencao or Materia Medica as Famine Food《救荒本草》(1946), etc. were partly translated into English. As for the translation form, it involves abridged, selected, and edited translations, but none of them are full translations.
2.1 Translation and Transmission of Xi Yuan Lu Xi Yuan Lu or Records for Washing Away Injustice《洗冤录》 written in 1247 by Song Ci (宋慈, 1186-1249), an official in the Southern Song Dynasty (1127-1279), is the first relatively complete monograph on forensic medicine in China and in the world as well - it has a great influence on the history of the world forensic medicine. Its contents are substantially rich, reflecting the abundant accumulation of knowledge and practical experiences in pathology, anatomy, pharmacology, surgery, orthopedics, and laboratory tests, etc., and showing an advanced level in technology and experiences. The book “has a high scientific value,” and “has once been translated into Dutch, English, 36
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
French, German, Korean, and Japanese languages, etc”.10 It was first transmitted to Korea, Japan, and then to Europe since its coming out: In 1779, Chinese Journal of History, Art and Science first published its abridged translation in Paris, France; In 1882, Ern Martin, a French doctor, published a thesis on its summary in Far Eastern Review; In 1908, a separate edition of its French translation was officially published. In June of 1853, “Royal Asiatic Society Newspaper” of Britain published Dr. W.A. Harland’s thesis (M.D.) – Collected Evidences of Records for Washing Away Injustice. In 1875, the translation by Dr. H.A. Giles11, a sinologist of Cambridge University, was published in instalments in The China Review; in 1924, The Journal of the Royal Society of Medicine reprinted the book and then its separate edition was published afterwards. We can say that two English translations of Xi Yuan Lu《洗冤录》were got published during this stage: one published in Hong Kong: Harland, W. A. Notice of a Chinese Work on Medical Jurisprudence, entitled Se Yuen Luh, or “Records of the Washing away of Injuries”. Hongkong, 1855; the other published in London: Giles, H.A. The “His Yuan Lu” or “Instructions to Coroners”. London: John Bale, Sons & Danielsson, 1924. As for the second translation, Wong, Chinmin K. introduced it in his paper Investigations of Western-language Translations of Chinese Medical Classics like this: “It was translated by Dr. H.A. Giles, a famous scholar in Oriental Culture of Cambridge University. Giles previously served as a consul to China. When he was in Ningbo in 1873, he saw autopsies by administrative officers, who always carried Xi Yuan Lu or Instructions to Coroners in hand, which arouse his interests to study and translate it.” In his view, “The wording is smooth and clear” and “The approach is correct and proper.”12 In addition, a Dutch translation by Degrijs, a Dutch man, was published in Batavia in 1863; and a German version translated from a French translation by Hoffmann was published in 1908.
10
Xia Zhengnong, 2002: 1827. Giles, H.A.（Herbert Allen Giles, 1845-1935）, Chinese name: 翟理斯, British, a famous Sinologist, the second professor in Sinology of Cambridge University. 12 Wong, Chinmin K., 1928: 103-105. 11
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Fengli Lan and Friedrich G. Wallner
2.2 Translation and Transmission of Huangdi Neijing Three English translations of Huangdi Neijing《黄帝内经》 came out in this period. The first one is from Dawson, Percy. M., who published a thesis to introduce Huangdi’s Inner Classic · Basic Questions in Annals of Medical History in 1925; The second is from Ms. Ilza Veith, a PhD candidate at Institute of History of Medicine of Johns Hopkins University at that time, who translated the first 34 chapters of Huangdi Neijing· Su Wen into English based on the manuscripts from an organic chemist J.W. Lindau with a large space to introduce Chinese medicine along with the translation: Veith, Ilza. The Yellow Emperor’s Classic of Internal Medicine. Baltimore: The Williams & Wilkins Co., 1949； The third is from Dr. Huang Wen 黄雯, who translated an important part of Huangdi’s Inner Classic into English along with comments and annotations and got it published as a separate edition: Wong, W. Nei Ching, the Chinese Canon of Medicine. Reprint from the Chinese Medical Journal – Special Medical History Number, V. 68. No. 1 & 2. Shanghai, 1950.
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2.3 Translation and Transmission of Bencao Gangmu The translation of Bencao Gangmu《本草纲目》 has always been a hot spot since its coming out. After Michel-Pierre Boym’s (1612-1659) edited translation in Latin – Flora Sinensis, which is actually an abridged translation of Bencao Gangmu, there are still some other translations: (1) Smith, F. P. Contribution towards the Materia Medica and Natural History of China. Shanghai: American Presbyterian Mission Press, 1871. The book has thousands of herbs, mostly from the Bencao Gangmu. (2) Stuart, G. A. Chinese Materia Medica · Vegetable Kingdom (Extensively revised from Dr. F. Porter Smith’s Work). Shanghai: Presbyterian Mission Press, 1911. Its contents are roughly from the herbs in the volumes 12 to 37 of Bencao Gangmu and is arranged in Latin alphabetical order, with three indexes of Chinese, English and botanical names, which is convenient to review and check13.
13
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Wong, Chinmin K., 1935: 1167-1170.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
(3) Read, B. E. & Pak, C. The Pen Ts’ao Minerals and Stones, Peking: Peking Society Natural History Bulletin, 1928; Read, B.E. Chinese Materia Medica · Animal Drugs, 1931; Chinese Materia Medica · Avian Drugs 1932; Chinese Materia Medica · Dragon and Snake Drugs, 1933; Chinese Materia Medica · Turtle and Shellfish Drugs, 1937; Chinese Materia Medica ·Fish Drugs, 1939; Chinese Materia Medica · Insect Drugs, 1941. Peiping: The French Book Store. Read, B. E., with a full name of Bernard Emms Read (1887-1949) and a Chinese name of 伊博恩, a British missionary to China, was a pharmacologist and a pioneer in Chinese pharmacology research.14 He successively translated and published the parts of Minerals and Stones, Animal Drugs, Avian Drugs, Dragon and Snake Drugs, Turtle and Shellfish Drugs, Fish Drugs, Insect Drugs, etc. of the Bencao Gangmu on the basis of the translation from Mills R., an American, between 1928 to 1941, namely the volumes from 8th to 37th and the volumes from 39th to 52nd, altogether 44 volumes, accounting for 86% of the book. Among the 44 translated volumes, except the part of Minerals and Stones from a joint translation with Pak, C., all the other parts were translated by himself. In the process of translation, Read identified the scientific names of herbs listed in the Bencao Gangmu as many as possible, stated effective ingredients and gave explanations according to Chinese and foreign references with an appendix of indexes with Chinese and foreign names of medicinal items. Many scholars and many works studied his translation. A widely-accepted evaluation about it is that the translation faithfully conveys the essence of the original, has a greater influence than most of the other English versions, and is a masterpiece for a full translation and further research on Bencao Gangmu. Besides, French and German translations of Bencao Gangmu were got published as well. It is worth noting that besides of translating Bencao Gangmu, Read also translated a part of the Jiuhuang Bencao《救荒本草》compiled by Zhu Di 朱棣 (1360-1424), the third emperor of the Ming Dynasty (1368-1644). There are 414 species of herbal plants in the translation, which was published in 1946 in Shanghai: Read, B.E. Famine Food listed in the Chiu Huang Pen Ts’ao. Shanghai: Henry Lester Institute of Medical Research, 1946.
14
Zhao Jimeng, 2012.
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Fengli Lan and Friedrich G. Wallner
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3
Overall Translation of Chinese Medicine (1951-1991)
This is a period of overall translation of Chinese medicine. The contents of translation cover almost every aspect of Chinese medicine from its theories to skills, involving acupuncture and moxibustion, Chinese herbal medicine, basic theories, clinical medicine, and Chinese medical classics, etc. In the years from 1956 to 1960, Chinese government established 20 colleges of Chinese medicine, which showed that, in addition to maintaining the traditional methods of transmitting Chinese medicine – “secret transmission” and “individual transmission”, Chinese medicine was transmitted on a large scale in China mainly through a westernized, modernized, and professionalized mode, i.e. “the standardized mode of transmission”. Then it came into the 1970s. A historical fact needs to be clarified: People of all circles in America have always thought that the public awareness of acupuncture and moxibustion was aroused because of James Reston’s (1909-1995) reports about his experiences during his visit in China with the former U.S. President Richard Milhous Nixon (1913-1994) in 1972, during which he suffered from an acute attack of appendicitis and was cured by acupuncture anesthesia. In real fact, it was in July 1971 that James Reston, a famous journalist and columnist of the New York Times, accepted an invitation alone and visited China with his wife. Henry Alfred Kissinger (1923-) had just ended his trip to Beijing (July 9th -11th) on one day before Reston’s arrival in Beijing, and announced that President Nixon would visit China before May of the next year. During Reston's visit in China, he asked for medical treatment in Beijing because of the unbearable abdominal pain and was finally diagnosed with an acute attack of appendicitis. Because of his serious condition, he was hospitalized at noon of July 17th in the Peking Anti-Imperialist Hospital (now the “Peking Union Medical College Hospital”). Five famous doctors of the hospital, including a famous surgeon Dr. Wu Weiran 吴蔚然 (1920-), et al. held a consultation and decided to give him an operation on that evening. After the operation, Reston felt unbearable abdominal distending pain, which was relieved by acupuncture given by an acupuncturist of the hospital – Dr. Li Zhanyuan 李占元. As Reston said there was “no recurrence of the problem thereafter”15.
15
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Reston, 1971.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
Thereafter, Reston visited an operation under acupuncture anesthesia in Shanghai: “It is an amazing experience for me to see you doing tumor resection under acupuncture anesthesia in Shanghai.” On July 26th, the US New York Times published special reports on the launch of Apollo and meanwhile splashed the story on the front page: “Now, About My Operation in Peking” with the headline “Now, Let Me Tell You About My Appendectomy in Peking”. James Reston’s significant influence and the position of New York Times in the press made his reports authentic, and therefore China’s acupuncture was known as the “Oriental Apollo” in the United States. Because of the reports, James Reston’s visit in China caught the world’s attention and started a craze for acupuncture in the United States, attracting a careful review of acupuncture therapy from a Western power for the first time. Unexpectedly, this event also encouraged Prof. Paul U. Unschuld (1943-) to research Chinese medicine, making an attempt to systematically introduce the long-standing history and current situation of Chinese medicine to the West.16 Soon afterwards, U.S. former President Richard Nixon watched a surgery under acupuncture anesthesia during his visit in China in February 1972. In the same year, the U.S. National Institute of Health (NIH) funded the first research project on acupuncture therapy, thus bringing acupuncture research to a climax for the first time. Therefore Chinese medicine and acupuncture got into the United States again. And then, Chinese medical theory and skills like acupuncture, moxibustion, herbal medicine, massage, qi gong or breathing exercise, diet therapy, ancient Chinese medical language and Chinese medical classics followed to have full access to the United States. As a follow-up, The American Journal of Chinese Medicine and American Journal of Acupuncture started their regular publications in 1973 in the USA; The Theoretical Foundation of Chinese Medicine: Systems of Correspondence by Manfred Porket, a German Scholar, was published by Cambridge, Mass. and. London: MIT Press in 1974; Celestial Lancets: a History and Rationale of Acupuncture and Moxa by Dr. Lu Gwei-Djen and Dr. Joseph Needham was published first by Cambridge University Press in 1980 and then reprinted in 2002 by Routledge Curzon in London;
16
Zheng Jinsheng, 2013: 3.
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Dr. Henry C. Lu, a Chinese Canadian, translated and published A Complete Translation of The Yellow Emperor’s Classics of Internal Medicine and the Difficult Classic (1978; 2004); Prof. Ted J. Kaptchuk, a scholar from Harvard Medical School, authored and published The Web That Has No Weaver: Understanding Chinese Medicine, the 1st edition, in 1982 and Chinese Medicine: The Web That Has No Weaver, the 2nd revised edition, in 2000, both of which have been one of the bestsellers on Chinese medicine in the West since its coming out, and successfully introduce Chinese medicine to the West and were reprinted numerous times and aroused immerse repercussions in the West; Giovanni Maciocia started to publish his series of textbooks on Chinese medicine in 1989 – The Foundations of Chinese Medicine, which has been one of the major series of textbooks for training practitioners of Chinese medicine in the West; Dr. Nigel Wiseman’s translation Fundamentals of Chinese Medicine (co-translated with Andrew Ellis, 1985) and his Glossary of Chinese Medical Terms and Acupuncture Points (1990) were published successively by Paradigm Publications; During this stage, Prof. Paul U. Unschuld published a series of books on Chinese medicine at University of California Press, including Medicine in China: A History of Pharmaceutics (1986), Nan-Ching: The Classic of Difficult Issues (1986), Medicine in China: A History of Ideas (1988), Forgotten Traditions of Ancient Chinese Medicine: The I-hsueh Yuan Liu Lun of 1757 by Hsu Ta-ch’un (1990); WHO (World Health Organization) issued the standardization of the English terms of acupuncture – A Proposed Standard International Acupuncture Nomenclature (Geneva, 1989) and Standard Acupuncture Nomenclature (Revised ed., Manila, 1991) as the outcome of the international cooperation since 1982. During this stage, English translations of Chinese medicine in China are as follows: In China, several International Acupuncture Training Centers were set up in Shanghai, Beijing, Nanjing, etc. by the aid of WHO. Ministry of Public Health and State Administration of TCM of China organized experts to compile and translate textbooks for beginners and advanced learners, i. e. Essentials of Chinese Acupuncture (1975, 1980) and Chinese Acupuncture and Moxibustion (1987), which have been used to train international acupuncturists up till now;
42
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
Dr. Luo Xiwen (罗西文, 1945-2012), a research fellow of China Academy of Social Sciences, translated and published Shanghan Lun《伤寒论》: Treatise on Febrile Diseases Caused by Cold (Shanghan Lun, Beijing: New World Press, 1986), prefaced by Dr. Joseph Needham (1900-1995); English-Chinese Edition of Practical Book Library on Chinese Medicine《英 汉对照实用中医文库》 (Zhang Enqin 张恩勤, 1990)，and English-Chinese Edition of A Practical Complete Collection of Chinese Medicine and Pharmacology 《英汉实用中医药大全》(Xu Xiangcai 徐象才, 1990-92) were published in China, which thus laid foundation for translation of different subjects of Chinese medicine; Ou Ming (歐明, 1924-), Xie Zhufan (謝竹藩, 1924-), Shuai Xuezhong (帥學 忠), et al. compiled and published different editions of “Chinese-English Dictionary of Chinese Medicine”.
4
Translation and Studies on Chinese Medicine: From Standardization of Its English Terminology, English Translation & Research of Its Classics, to Interpretation of Its Way (1992-)
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4.1 Standardization of English Translation of Chinese Medical Terminology A great number of English works on Chinese medicine have got published at both home and abroad since 1992, covering foundations of Chinese medicine and acupuncture, all clinical subjects, and Chinese medical classics, including English translations and English writings. Among them, the domestic presses and academic journal editorial departments on Chinese medicine have not yet appointed a standard English terminology for their English publications on Chinese medicine; While in the United States, Paradigm Publications and Blue Poppy Press, two of the three major Chinese medical literature publishing houses, have appointed English Chinese medical terminology formulated by Dr. Nigel Wiseman as the standard terminology for their publications. Dr. Nigel Wiseman’s English-Chinese and Chinese-English Dictionary of Chinese Medicine (Changsha: Hunan Science & Technology Press, 1995), and A Practical Dictionary of Chinese Medicine (Brookline, Massachusetts: Paradigm Publications, 1998; Beijing: People’s Medical Publishing House, 2002) were successively published and the free online dictionary Paradigm Online TCM Dictionary (an updated version in 2011) is available at the website of Paradigm Pub-
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lications – http://www.paradigm-pubs.com/TermList to promote this terminology, which contains more than 35,000 entries and convenient two-way access – Chinese-English, English-Chinese. The research project “Standard English Translation of TCM Nomenclature” chaired by Prof. Xie Zhufan (谢竹藩, 1924-) and sponsored by the State Administration of TCM results in the publications of Classified Dictionary of Traditional Chinese Medicine (New Edition) in 2002 and On the Standard Nomenclature of Traditional Chinese Medicine in 2003 by Foreign Language Press in Beijing to promote this terminology at home and abroad respectively. Chinese Terms in Traditional Chinese Medicine and Pharmacy 《中医药学名 词》, the research outcome of a project “Research on Standardization of Basic Terms in Traditional Chinese Medicine and Pharmacy (Chinese-English)”, which was sponsored by Ministry of Science and Technology of China and chaired by Academician Wang Yongyan (王永炎, 1938-), Prof. Liang Jusheng 梁菊生, Prof. Zhu Jianping 朱建平 of China Academy of Chinese Medical Sciences, was examined and approved by the China National Committee for Terms in Sciences and Technologies and published by Science Press (Beijing) in 2005. But its standard English terminology set off controversies among the academic circle in China. For example, Prof. Xie Zhufan 谢竹藩 et al. found various mistakes among the English equivalents in the book Chinese Terms in Traditional Chinese Medicine and Pharmacy, which were classified into eight categories: grammatical errors, violation of English idioms, total ignorance of the original implications, partial reflection of the Chinese original, erroneous use of general medical terms, erroneous use of specific medical terms, violation of medical principles, and wrong interpretation of pharmaceutical concepts. For each category, three examples were given. The mistakes found in the book counted up to ten times the number of examples. In addition, much more English equivalents were found in want of standardization. However, since the book was published as a formal document with compulsory application approved and promulgated by China National Committee for Terms in Sciences and Technologies, it has given wrong directions domestically and made an unfavorable impact abroad.17 In 2004, World Health Organization（WHO）launched the work of “International Standardization of Terminology on Traditional Medicine” and announced WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region on October 16th, 2007, and thus laying a foundation 17
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Xie Zhufan, et al. 2006: 169-172.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
for standardization of traditional medicine in the future. Actually there are also some mistakes in this proposal, such as “terminologies” in the title, triple “energizers” for 三焦, and so and so forth.
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4.2 English Translation and Research of Chinese Medical Classics Translations of many Chinese medical classics were got published at home and abroad up till this period. Huang Di Nei Jing 《黄帝内经》or Huangdi’s Inner Classic (including Su Wen 《素问》or Basic Questions and Ling Shu 《灵枢》or Miraculous Pivot), Shennong Bencao Jing《神农本草经》 or Shennong’s Classic of Materia Medica, Shang Han Lun 《伤寒论》or On Cold-induced Diseases and Jingui Yaolǜe 《金匮要略》or Synopsis of the Golden Chamber by Zhang Zhongjing (张仲景, 150-219), Mai Jing 《脉经》or The Pulse Classic by Wang Shuhe (王叔和, 201-280), Zhenjiu Jiayi Jing 《黄帝针灸甲乙经》 or The Systematic Classic of Acupuncture and Moxibustion by Huangfu Mi ( 皇 甫 谧 , 215-282), Zhong Zang Jing《中藏经》or The Classic of the Central Viscera, whose authorship is attributed to Hua Tuo in legends (华佗, ?-203), Beiji Qianjin Yaofang·Furen Fang《备急千金要方•妇人方》or Prescriptions Worth a Thousand in Gold for Every Emergency (Invaluable Prescriptions for Emergencies)·3 Volumes of Gynecology by Sun Simiao (孙思邈, 581-682), Yin Hai Jing Wei 《银海精微》or Essential Subtleties on the Silver Sea, whose authorship is attributed to Sun Simiao in legends, Xi Yuan Lu 《洗冤录》 or Records for Washing Away Injustice by Song Ci (宋慈，1186-1249), Pi Wei Lun《脾胃论》or The Treatise on Spleen and Stomach by Li Gao (李杲, 1180-1251), Heart Approach to Gynecology 《妇科心法要决》, the part of gynecology of Yi Zong Jin Jian 《医宗金鉴》 or Golden Mirror of Medicine, the official textbook of Chinese medicine of the Qing Dynasty (1644-1911), Bencao Gangmu 《本草纲目》or The Compendium of Materia Medica and Binhu Mai Xue 《濒湖脉学》 or Lakeside Master’s Study of the Pulse by Li Shizhen (李时珍, 1518-1593), Ge Zhi Yu Lun 《格致余论》or Extra Treatises Based on Investigation and Inquiry and Dan-Xi Zhi Fa Xin Yao 《丹溪治法 心要》or The Heart & Essence of Dan-Xi's Methods of Treatment by Zhu Zhenheng (朱震亨,1281-1358), Wen Bing Xue 《温病学》 or Warm Disease Theory, Fu Qing-zhu Nu Ke《傅青主女科》or Fu Qing-Zhu’s Gynecology by Fu Qing-zhu (傅 青主, 1607-1684), Yixue Yuan Liu Lun 《医学源流论》 or The Origin and Development of Medicine by Xu Dachun (徐大椿, 1693-1771)，Yi Lin Gai Cuo or Correcting the Errors in the Forest of Medicine 《医林改错》 by Wang Qingren (王
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清任, 1768-1831), etc, have been fully translated into English, but the translation versions are confused with good or bad qualities. And some classics have two or more translations, e.g. Huang Di Nei Jing Su Wen 《黄帝内经素问》has around 10 translations, and other classics like Huang Di Nei Jing Ling Shu 《黄帝内经灵枢》, Nan Jing 《难经》, Shang Han Lun 《伤 寒论》, Jingui Yaolue《金匮要略》, Mai Jing 《脉经》 ，and Binhu Mai Xue 《濒 湖脉学》etc. have at least two translated versions. Besides, translations of medical manuscripts from Mawangdui Han tomb (No. 3) unearthed in 1973 18 and Dunhuang19 discovered in 1900 have also got published: Early Chinese Medical Literature: the Mawangdui Medical Manuscripts (Donald John Harper, 1998) and Medieval Chinese Medicine: The Dunhuang Medical Manuscripts (Needham Research Institute Series, Vivienne Lo & Christopher Cullen, 2005).20 Among the translations of classical Chinese medical texts, Huang Di Nei Jing Su Wen Project and Bencao Gangmu Project chaired by Prof. Paul U. Unschuld (1943- ) are the two largest, most time-consuming, most costly projects on the research and translation of Chinese medical classics involving the most extensive international cooperation and with most research outcomes ever. On May 25th. 2011, Huang Di Nei Jing Su Wen and Bencao Gangmu were both included into the Memory of the World Register by UNESCO (United Nations Educational，Scientific and Cultural Organization)，which shows that Prof. Unschuld’s selection of research topics just hit the mark. Huang Di Nei Jing Su Wen Project sponsored by Volkswagen Foundation and German Research Foundation (DFG) was accomplished through 22 years (1989-2011) of international cooperation with Hermann Tessenow, a philologist
18
“The Mawangdui Medical Manuscripts” represent the richest cache of ancient medical manuscripts ever found in China, which was identified as the medical knowledge in third and early second century B.C. China, including discussions of meridians, physiological theories and pathology, prescriptions & recipes for the treatment of ailments and for the practice of macrobiotic hygiene, sexual treatises, and illustrations of hygienic exercises. 19 In 1900, a Chinese Daoist Priest Wang Yuanlu (王圆箓, 1850?-1931) uncovered a cache of thousands of paintings and manuscripts in the Silk Road town of Dunhuang 敦煌 in the northwest China. Formerly walled up in a man-made cave in about 1035, these materials now constitute one of the most valuable sources on China and central Asia during the first millennium CE. Its medical parts are known together as Dunhuang Medical Manuscripts 敦煌医书. 20 You may know the available translations of classical Chinese medical texts in details at http://www.redwingbooks.com.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
of Institute of History of Medicine of Munich University, and Zheng Jinsheng 郑金生, a research fellow of China Academy of Chinese Medical Sciences. The University of California Press successively published their research outcomes: Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in An Ancient Chinese Medical Text (2003), a research monograph to comprehensively introduce Huang Di Nei Jing Su Wen; Dictionary of Huang Di Nei Jing Su Wen (2008), a research tool and index of Huang Di Nei Jing Su Wen with 1,886 Chinese characters as the key link; Huang Di Nei Jing Su Wen: An Annotated Translation of Huang Di’s Inner Classic – Basic Questions (2 Volumes, 2011), a full translation of the 79 chapters of the Wang Bing (王冰, 710-804) annotated Su Wen based on methods of linguistic anthropology. The Bencao Gangmu Project first approved in 1988, re-started in 2008 in international cooperation with experts of different fields of study. This project, another time-consuming research project, is currently in smooth progress. Historical Chinese Illness Terminology, which analyzes around 4,500 terms of diseases, the first volume of the first research outcome A Dictionary of the Bencao Gangmu (4 Volumes), will be published in 2014.
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4.3 Understanding the “Way” of Chinese Medicine It is worth noting that Chinese medicine has gradually gained a legal identity and status as well as understanding and acceptance by the American government during this period. On March 7th, 2000, William Jefferson Bill Clinton (1946 -), a former U.S. President, issued No. 13147 Executive Order and approved the establishment of White House Commission on Complementary and Alternative Medicine, C.A.M for short. After about two years of investigation and research by C.A.M., the FINAL REPORT of the White House Commission on Complementary and Alternative Medicine Policy was announced at the end of March, 2002. In the report clearly safe and effective CAM medical practices and products are required to incorporate into the routine health care in the United States and increasing funding for the study of these treatments is also proposed.21 As the report is from the American government, it has undoubtedly a significant and far-reaching impact on the existing health care system and the development
21
See http://whccamp.hhs.gov//finalreport.html in details.
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of integrative medicine. So far, Chinese medicine, acupuncture and moxibustion in America have gained a “legal identity and status”.
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4.3.1 Chinese Medicine: A Complete Medical System Rooted in Chinese Culture Science depends on culture. This point of view has been developed through (1) Thomas Samuel Kuhn (1922-1996), one of the most influential philosophers of science of the twentieth century, see The Structure of Scientific Revolutions, Chicago: University Of Chicago Press, 1996; (2) Paul Feyerabend (1924-1994), a critic of Karl Popper's “critical rationalism” and one of the twentieth century's most famous philosophers of science, see Against Method, London: New Left Books, 1975; and Realism, Rationalism and Scientific Methods: Philosophical Papers, Volume 1, Cambridge: Cambridge University Press, 1981; (3) Friedrich G. Wallner (1945- ), the founding father of Constructive Realism, an intercultural and interdisciplinary philosophy of science with the aim of making the manifold scientific approaches depending on different cultures understandable, see Constructive Realism: Aspects of A New Epistemological Movement, Wien: W. Braumueller, 1994. In December 2006, Food and Drug Administration (FDA) mentioned that traditional Chinese medicine is a complete medical system with its own theory and practice, derived from classical Chinese culture and evolved simultaneously and independently with Western medicine in the [Guidance for Industry on Complementary and Alternative Medicine Products and Their Regulation by the Food and Drug Administration (DRAFT GUIDANCE)]. Of course Traditional Indian medicine is no exception (FDA, 2006). The original is as follows: “The term ‘complementary and alternative medicine’ (CAM) encompasses a wide array of health care practices, products, and therapies that are distinct from practices, products, and therapies used in ‘conventional’ or ‘allopathic’ medicine. Some forms of CAM, such as traditional Chinese medicine and Ayurvedic medicine, have been practiced for centuries, whereas others, such as electrotherapy, are more recent in origin.”, and that “NCCAM describes whole medical systems as involving ‘complete systems of theory and practice that have evolved independently from or parallel to allopathic (conventional) medicine.’ These may reflect individual cultural systems, such as traditional Chinese medicine and Ayurvedic medicine.” 48
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This statement from FDA in 2006 shows the general official acknowledgement of cultural dependency of medical systems. As for Chinese medicine, it is a culturally dependent medical system deeply rooted in the culture and philosophy of the country it originated from: China. That is to say, Chinese medicine is not simply an old healing art indigenous to China with a basic understanding of the human body and diseases and mainly composed of effective herbal formulas and acupuncture techniques nor a healing system that can be gauged according to Western scientific criteria, but is a systematic, independent and complete medical system in and of itself, rooted in Chinese culture, that cannot be adapted to suit the Western conventional medical approach.
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4.3.2 The Way of Chinese Medicine: Qu Xiang Bi Lei or Metaphorizing Chinese medicine as we know it today is the product of a systematic organization of the knowledge contained in the ancient Chinese medical classics. Up until now, Chinese medicine has still claimed that it follows the system founded in classical texts such as Huang Di Nei Jing or Huang Di’s Inner Classic, Nan Jing or The Classic of Difficult Issues, Shang Han Lun or On Cold-induced Diseases, Jin Gui Yao Lue or Essential Prescriptions of the Golden Cabinet, Shen Nong Ben Cao Jing or Shennong’s Classic of Materia Medica, essentially. As all the ancient Chinese medical classics bear historical, cultural, and medical values, the study of their English translation cannot be confined to the field of History and Literature of Chinese Medicine, it is rather the key and difficult point of cross-cultural transmission and exchanges of Chinese medicine.22 Based on the authors’ cooperation research outcome of the projects “Cultural Dependency of Medical Knowledge: A Comparison between Chinese Medicine and Western Medicine from the Perspectives of Philosophy of Science”(2007-2010), “Theory, Methodology and Structure of TCM” (2008-2011; 2012-), One Branch Project of Joint Research Project of the TCM Research Cluster Austria together with the Sino-Austrian Collaborating Centre for Chinese Medicine Research: TCM and Age Related Diseases, sponsored by Austria, and “A Corpus-based Translation Study on Classical Chinese Medical Texts” (2009-2013) sponsored by China, the way of Chinese medicine is interpreted as: Chinese medicine takes Tian Ren He Yi 天人合一 or The Unity of Heaven and 22
Lan Fengli, 2012: 253-258.
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Humankind, as its ontological presupposition and Qu Xiang Bi Lei 取象比类 or Taking Image and Analogizing, as its core methodology; Qu Xiang Bi Lei is the process and the way of forming metaphors in Chinese medicine. Chinese medicine, from the writing form it is recorded in and carried on, to the formation of its concepts, to its terminology, its way of formulation, its logic, and even to the system in its entirety, it is essentially metaphorical. Interpreting metaphors is, therefore, the key to understand Chinese medicine, thus enabling it being carried forward and developed.23
4.3.3 How to Keep the Way in Translations of Classical Chinese Medical Texts Based on the interpretation of Chinese medicine in the sense of philosophy of science and a C-E comparable corpus of ancient Chinese medical classics (Chinese Corpus composed of 13 ancient Chinese medical classics with 1.485 millions of sinograms; English Corpus composed of 22 translations of the above mentioned classics with 2.62 millions of words), the research project “A Corpus-based Translation Study on Classical Chinese Medical Texts” sponsored by National Social Sciences and Philosophy Foundation of China studies the English translation of these ancient Chinese medical classics. Through this process, the following conclusions were reached: Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
A. In view of preserving the unique features of each of the two languages of Chinese medicine and Western medicine, as well as their complementarity and the differing philosophical foundations of both medical systems, the necessity of applying certain translating principles so as to preserve the metaphors, the systematic quality, wholeness and independence of the Chinese medical concepts, should be strictly observed. In this regard, “foreignization” or a source-target translation approach should be adopted, and the excessive use of Western medical terms to translate Chinese medical concepts should be avoided. Consequently, literal translation based on metaphor cognition and etymology investigation should be taken as the chief method in translating Chinese medical terminology. B. In view of the fact that all ancient Chinese medical classics bear historical, medical and cultural values, the classics require an extremely close translation, 23
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Lan Fengli & Wallner, Friedrich. 2014: 87-93.
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Transmitting Trend of Chinese Medicine in the West: From Skills to Way
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not an ‘interpretation’ of the original, as the translation itself should be able to support as many different interpretations as the original does. For this purpose, the original Chinese text (including terms, structure of the sentences and discourses as well as the figures of speech contained in it) should be given a literal translation wherever/whenever possible. Meanwhile, reliable commentaries from both the experts of the past and the translator should be added in the notes in order to provide the English readers with the opportunity to experience the process of studying Chinese medical classics in a way similar to that of the Chinese readers.24
To sum up, transmission of Chinese medicine in the West started in the 17th century, originating from the real therapeutic effect of Chinese therapies, i.e. the transmission of “Skills” such as pulse-taking & reading skills, moxibustion treatment for gout, acupuncture treatment for arthritis, translation and introduction of Chinese herbal medicine (e.g. Bencao Gangmu 《本草纲目》or The Compendium of Materia Medica) and forensic medicine (e.g. Xi Yuan Lu 《洗冤 录》or Records for Washing Away Injustice), and so and so forth. In the 20th century “the craze for acupuncture” and “the craze for Chinese medicine” in the West are also closely related to the success of acupuncture anesthesia in the Mainland China. After more than 300 years of rises and falls, Chinese medicine is now spreading at an unprecedented speed, scale and depth in the West. Transmission of “Dao or Way”, in addition to transmission of “Skills”, is also a need and choice of the era when reflecting on the advantages and disadvantages of modern science and Western Medicine. As Prof. Paul U. Unschuld repeatedly emphasizes that “People like a medicine not because it is effective, but because they like the ideas it is based on (or they think it is based on)”25.
24
Lan Fengli. 2014: Abstract. Quoted as a secondary source from Dr. Nigel Wiseman’s Lectures in Shanghai: Wiseman, Nigel. Chinese Medical English in the Wider Context of International Communication (Lecture 1). A Series of Lectures at Shanghai University of TCM. June 3, 2013. 25
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References
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1
Huang Qichen. Transmission and Influences of Chinese Culture in Europe from 16th to 18th Century [J] . Journal of Sun Yatsen University (Social Science Edition), 1992, 4: 54-62. 2 Lan Fengli. Culture, Philosophy and Chinese Medicine: Viennese Lectures [M]. Frankfurt am Main: Peter Lang, 2012. 3 Lan Fengli & Wallner, Friedrich. The Metaphorizing Process and the Way of Forming Metaphors in Chinese Medicine [J]. Journal of Dialectics of Nature, 2014, 36(2): 87-93. 4 Lan Fengli. A Corpus-based Translation Study on Classical Chinese Medical Texts [M]. In Print, 2014. 5 Li Xisuo, Chen Shangsheng. 5,000 Years of Sino-Foreign Cultural Exchange [M]. Beijing: World Knowledge Press, 2002. 6 Li Xisuo, Lin Yanqing, Li Mengzhi, et al. 5,000 Years of History of Sino-Foreign Cultural Exchange (Vol. 2) [M]. Beijing: World Knowledge Press, 2001. 7 Ma Boying, Gao Xi, Hong Zhongli. History of Sino-Foreign Medical Cultural Exchange: Sino-Foreign Cross Cultural Communications [M]. Shanghai: Wenhui Press, 1993. 8 Originally by Matteo, Ricci. Translated by He Gaoji, Wang Zunzhong, Li Shen. Matteo Ricci’s Reading Notes on China [M]. Beijing: Zhonghua Book Company, 1983. 9 Pan Jixing. Transmission of Chinese Culture in the West and Its Influences on Darwin [J], Science, 1954 (10). 10 Pan Jixing. Transmission of Chinese Biological Works in Europe before the Time of Darwin [J]. Bulletin on Biology, 1959 (10): 521-525. 11 Qiu Le. A General Review of Research on Historical Facts of English Translation of Ancient Traditional Chinese Medicine Books [J]. Journal of Chinese Integrative Medicine, 2011; 9(4): 459-464. 12 Reston, James. Now, Let Me Tell You About My Appendectomy in Peking [N]. New York Times, Monday July 26, 1971. 13 Voltaire. Essai Sur Les Moeurs (Vol.2) [M]. Paris: Gamier, 1963. 14 Wallner, F.G., Lan F.L., Jandl M.J., et al. Theory, Methodology, and Structure of Chinese Medicine [C] (Vol. 1-3). Frankfurt am Main: Peter Lang, 2010-2011. 15 Wiseman, Nigel. Chinese Medical English in the Wider Context of International Communication (Lecture 1). A Series of Lectures at Shanghai University of TCM. June 3, 2013. 16 Wong, Chinmin K. Investigations of Western-Language Translations of Chinese Medical Classics [J]. National Medical Journal of China, 1928, 14(2): 103-105. 17 Wong, Chinmin K. Investigations of English Translations of Bencao Gangmu [J]. National Medical Journal of China, 1935, 21(10) : 1167-1170.
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Wong, Chinmin K. & Fu Weikang. Title Catalogue of Writings on Chinese Medicine in Foreign Languages（1656-1962）[M]. Shanghai: Museum of History of Medicine of Shanghai College of Traditional Chinese Medicine, 1963. 19 Xia Zhengnong. Ci Hai or An Unabridged Comprehensive Dictionary [Z]. Shanghai: Shanghai Lexicographical Publishing House, 2002. 20 Xie Zhufan, Liao Jiazhen, Liu Ganzhong, et al. Comments on the English Equivalents of Chinese Terms in Traditional Chinese Medicine and Pharmacy [J]. Chinese Journal of Integrated Traditional and Western Medicine, 2006, 26 (2): 169-172. 21 Zhao Jimeng. A Brief History of Modern Pharmacology of Chinese Herbal Medicine in China [D]. Master Dissertation of China Academy of Chinese Medical Sciences, 2012. 22 Zheng Jinsheng. Prof．Unschuld’s Path of Researching the History of Medicine in China [J]. The Chinese Journal for the History of Science and Technology, 2013, 34(1): 1-17.
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The Whole – The Starting Point of Understanding Disease in TCM Zhang Lishan (Dongzhimen Hospital, Beijing University of Chinese Medicine)
Abstract
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The concept of holism is an important idea in TCM. It connects one part of the body with another and links the human body with nature as well.It instructs us to know about the integrated relationship among each part of human body and the relationship between the human body and nature from the aspects of physiology, pathology, diagnosis and therapy. The idea of correspondence between human and nature is the best explanation and reflect of this overall view and idea.
Key words Traditional Chinese Medicine, The concept of holism correspondence between human and nature The classical Chinese materialism and dialectics are the philosophical foundation of Traditional Chinese medicine, which is composed of essential-qi theory, Yin-Yang theory and five elements theory. With the method of comprehensive thinking, people can analyze and solve problems about medical theories and clinical practices and so on, where fully reflect the characteristics of rational thinking of the Chinese traditional culture.
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1
The connotation of the concept of holism
The concept of holism is applied to understand the integrity, unity and connection among objects and phenomena.In ancient china, the concept of holism is a unique form or way in thinking, which is founded on classical Chinese materialism and dialectics such as essential-qi theory Yin-Yang theory and five elements theory, which also emphasize the connection, harmony and coordination as a whole. The concept of holism in TCM means that the human body is an organic whole and that human beings are interrelated with nature (the external environment). Therefore, from this perspective, people come to understand and study the physiology, pathology, diagnosis syndrome differentiation and treatment. The human body is an organic whole. The five zang-organs are the center of the body, which store essential-qi, and house spirit. The human body is composed of various tissues and organs, including the viscera, the six fu-organs,the five vessels, the five sensory organs, the nine orifices, the four limbs and all the skeletal parts. These different tissues and organs are united into an organic whole through the meridian system that pertain to the viscera in the interior and connect with the limbs and joints in the exterior. With the assistance of essence, qi, blood, body fluid, the human body can complete integrated functional activities, and coordinate spiritual consciousness activities as well. The human body relies on the functional role of various organs and tissues of their normal play, along with the synergistic effect and restrictive function among organs and tissues to maintain the equilibrium and coordination in physiological activities. The book Huangdi’s canon of Medicine says, “man is in correspondence with the heavens and the earth, and with the sun and the moon”. This explains that man with nature is an integral whole, the regularity of human life is closely related to changes in the nature. Man lives in the natural world that provides him with all the necessities indispensable to his existence. At the same time, the changes in nature directly or indirectly affect the human body. The integrate relationship between man and nature mainly reflects on the influence of climate, day and night and local area on man. Take seasonal changes for example, usually spring is marked by warmth, summer by heat, late summer by dampness, autumn by dryness, and winter by cold in a year. Under the influence of such changes, the living things on earth will also change to adapt to environmental variation, such as sprouting in spring, growing in summer,alternation in late summer, ripeness in autumn and storage in winter. In a day with the change of the wax and 56
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wane between yin and yang along with the day and night, the body’s yin, yang, qi, blood is going on corresponding adjustment to environmental changes. The book entitled Miraculous Pivot says “a day can divided into four seasons, morning is the spring, noon is the summer, afternoon is the autumn, midnight is the winter”. The temperature changes in the day and night. Although the change is not as obvious as in the four seasons in some degree, there exists similar periodic variation of wax and wane between yin and yang in spring, summer, autumn and winter. The change produces certain effect on the body’s physiological activities. Due to differences in regional climate, geographical environment and living habits, the nature as well effects the body’s physiological activities at a certain degree.
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The concept of holism and disease
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2.1 The concept of holism and disease etiology For the categories of pathogenic factors, in the song dynasty Chen Yan in his book entitled Treatise on the Three Categories of Pathogenic Factors and Prescriptions summarized the cause of diseases into three categories, namely “internal cause, external cause, and causes neither internal nor external”. It treat six evils (including pathogenic wind, pathogenic cold, pathogenic summer-heat, pathogenic dampness, pathogenic dryness, pathogenic heat) as the external cause, internal injury due to seven emotions as internal cause, improper diet and overstrain, injuries caused by falling, incised wound and insect or animal bites as causes neither internal and external. During the course of a disease, external cause along with internal cause is an integrate whole. The book Plain Questions, therefore, states “the invasion of pathogenic factors into the body is caused by insufficiency of healthy qi” and “when vital qi exists in the body, the exogenous pathogens can not attack the body”. The occurrence of disease results from invasion of pathogenic factors into the body and struggle between pathogenic factors and healthy qi, while invasion of pathogenic factor is an important condition for the occurrence of a disease. There is a limit to human ability to adapt to the natural environment. If climate changes extremely or suddenly, which exceed the limits of regulatory function of the human body at a certain degree, or due to dysfunction of human body, the body is unable to adapt itself to the change of the climate, both lead to the occurrence of disease. Seasons, climate, day and
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night, and regions have great influence in the course of disease occurrence and development. In short, from the TCM perspective, the cause of disease is various. To make a summarization, they are excessive pathogens and insufficiency of the healthy qi while pathogenic factors include the six exogenous evils and endogenous pathogens which come from improper diet, abnormal changes of emotions, overstrain, such as phlegm and turbid pathogen, blood stasis, water and damp, and heat stasis ect. From the TCM perspective, when we analyse the cause of disease that a certain patient get, we take the whole into consideration. Take cold for example, a common syndrome called “cold enveloping fire”, owing to interior heat as well as invasion of wind-cold.This internal heat may be formed by emotional stress, over eating spicy food or the patient himself own the constitution of yin deficiency with effulgent fire.
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2.2 The concept of holism and disease pathology From the TCM perspective, when we come to understand the pathology of disease, we take the whole into consideration.The following example is used to explain that there is needed to consider the mutual effect between zang-organs and fu-organs in understanding disease pathological changes. The book Huangdi’s canon of Medicine says, “the five zang-organs and the six fu-organs all can lead to cough, not only the lung”. Cough is caused directly by the disorder of lungs in descending and liquefying, but as the zang-fu organs are closely related to each other, another disordered zang-organ or fu-organ may also lead to dysfunction of lungs, causing coughing. A patient who get a cough with the syndrome of internal retained phlegm-dampness, clinically manifested cough in the morning,excessive phlegm, especially after eating greasy food, raw or cold food, loose stool ect.The cough is caused by improper diet which injuries spleen and stomach. Under the condition of this dysfunction, the fluid and food can’t be transformed and transported as normal so that internal phlegm-dampness come into being and stagnate in the lungs leading to the occurrence of cough. Many patients with chronic bronchitis mainly fall into this category. Next I’d like to examplify the relationship between the time and the pathology of diseases. Lots of patients with asthma tend to give an attack in the nights. In the year of 1995 there was one patient in Inner Mongolia who got the asthma attack at 1:00 am, but he acted like healthy people after 4:00 am during the time in hospital. The time between 1:00 am and 4:00 am is in the charge of liver meridian and 58
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gallbladder meridian according to the theory of meridian system, and there is a meridian which is connected between the lung and the liver. As the patient is worried about his condition, this emotion causes liver depression and qi stagnation.At 1:00 am, the rising of liver Qi and gallbladder Qi transport disorder, which leads to the dysfunction of Lungs in descending and liquefying, then comes the asthma attack. In conclusion, the constitution of the patients, the change of external climate, the difference of areas and time need to be considered when you try to learn the pathology of the disease from the TCM perspective. There is no need to introduce each case like this since too many have happened.
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2.3 The concept of holism and disease diagnosis When we observe and diagnose disease clinically in TCM, the theory is mainly based on that “viscera inside the body must manifest themselves externally”, a quotation from the Mencius, and “inspection of the exterior manifestations will enable one to know the interior states, and know what diseases cause trouble”, a quotation from Miraculous Pivot. Man is in correspondence with the nature, we can’t treat symptoms and signs in isolation, but connect them with climate, seasons, regions, living habits temper likes and dislikes, make comprehensive analysis by the four examinations, and know the state of illness entirely. Only in this way can we make an right diagnosis.Just as stated in Plain Questions, “When treating diseases sages (excellent doctors) must know Yin and Yang in the heavens and the earth, order of the four seasons … by examining certain parts of the patient’s body, they can understand the root cause of the disease. Besides they take Bazheng (normal Qi from eight kinds of wind in the four seasons) and Jiuhou (Tree Regions and Nine Divisions for pulse examination) into full consideration.Only through such a careful and synthetic examination and analysis can they make diagnosis accurate.” In the year of 1957, a famous doctor named Guo Keming in the city of Shijiazhuang treated the Epidemic Encephalitis B with Baihu Tang, coming with good effect in Beijing. In the next year he used this prescription again to treat Epidemic Encephalitis B in Beijing, while, it didn’t work out well with a continuous fever. Later the doctor Pu Fuzhou was invited to consult. He applied the theory of five circuits and six qi and calculated that this Cangzhu should be added into this prescription to eliminate dampness due to the present humid
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weather. Then comes the great success with the Cangzhu baihu Tang-based new prescription.This presentation shows that the therapy need a little adjustment when the time changed or the climate is different though infected with the same encephalitis B virus.In the year of 1958 Dr Guo didn’t take the change of time, climate into consideration, which lead to the failure of the treatment concerning of the deviation in diagnose.
2.4 The concept of holism and disease treatment I will state them from the following three aspects.
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2.4.1 Three categories of etiological factors system Man is in correspondence with the heavens and the earth, and with the sun and the moon. Man lives in the nature. Man with the nature is an integral whole. Therefor when we come to understand the physiology, pathology, disease treatment, we should take the seasonal condition, local conditions and the patient's individuality into consideration. This is the foundation for the formation of the theory of three categories of etiological factors system. Three categories of etiological factors system, means treatment in accordance with seasonal conditions, treatment in accordance with local conditions, treatment in accordance with the patient’s individuality. It is a principle in treating disease according to the different time rhythm changes and seasonal climate characteristics. The book Plain Questions says “Cold avoided coldness, cool avoided coolness, warm avoided warmth, heat avoided heat. This principle should be abided by when taking foods”. It means that when we use drugs whose nature is cold and cool, we should avoid cold season, the rest can be done in the same manner. The doctor can’t be a mastered one, if he didn’t know the laws of nature when treating a disease. For instance, the meaning that some diseases occuring in winter can be cured in summer is tonifying the Yang Qi of human body when it is at its most in nature in the hot summer to dredge the meridians. In this way, the patients would get less athsma attack. We can see that this kind of therapy that concur to the changing law of nature and the human body is yielding twice the result with half the effort, while, the treatment effect is much less satisfying if it is applied in other seasons.Treatment in accordance with local
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conditions, just as stated in Plain Questions, “In treating diseases, doctors use different therapeutic methods to treat the same disease, but the curative effect is the same. What is the reason? ... This is due to the geographical difference. For example, the east … cured by stone-needle … the west … be treated by Duyao (drugs) … the north … be treated by Jiuruo (moxibustion) … the south …. cured by acupuncture with small needles … the central region … treated by Anqiao”. This is because the difference in regional climates, diet and residence,living habits, leading to the occurrence of different disease, as a result, the treatment should also be different. As for treatment in accordance with the patient’s individuality. Such as with a cold fever, in TCM treatment we choose to promote sweating to release the exterior, but promoting sweating may consume blood and body fluids easily. With regard to the man with a strong constitution, we can promote sweating to release the exterior. As for the man with a weak constitution, especially for the old people, we should apply tonic drugs at the same time, so as to prevent sweating too much from damaging healthy qi or arising other pathological changes. Even sometimes, we tonify healthy qi firstly, and then promote sweating to release the exterior, when the healthy qi is sufficient.
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2.4.2 Viscera related The human viscera is closely related to each other, therefore, we need to concern about the other viscera organs when treating one of them. For instance, Zhang Zhongjing in Eastern Han Dynasty said in Treatise on Exogenous Febrile and Miscellaneous Diseases “observing dysfunction of the liver, aware of that the spleen may get involved, tonify the spleen first” That is, when the liver is not working right, the spleen and stomach tend to get affected according to the Theory of Five elements which said that the liver belongs to wood, the spleen belongs to earth, the former one restricts the latter one. Consequently, we need to tonify spleen in case it is affected though there is no syndrome in the spleen and stomach at that time. That becomes a significant principle when the later doctors treat liver disease. Moreover, the TCM emphasize that we need to take care of the spleen and stomach as they are the source qi, blood and body fluids. There are a lot prescriptions in Treatise on Exogenous Febrile Diseases that reflect this concept of holism. For example, the fresh ginger, Chinese date are used to protect the stomach in GuizhiTang and ChaihuTang. The polished roundgrained rice, liquorice root are used to tonify the stomach in the BaihuTang
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when gypsum, common anemarrhena rhizome are used to clear heat. That all fully reflects the concept of holism in TCM therapies.
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2.4.3 Holistic therapy As for therapeutic methods, we adopt holistic therapy due to the effect of holistic concept in TCM. According to the theory of TCM, diseases occur when the dynamic equilibrium in the interior of the body as well as between the human body and the environmental conditions is damaged. So when we treat disease, we adopt drugs with the effect of eliminating the pathogenic factors and strengthening the body resistance to readjust the body function, and eliminate disease by using the body's own disease-resistant mechanism, so as to restore the dynamic equilibrium of the system. TCM attaches great importance to reinforce the healthy qi, which means strengthening the body resistance. Whether it is used to nourish yin and tonify blood or benefit qi for warming yang, they aim to achieve recovery by strengthening the body resistance.Eliminating the pathogenic factors means capitalizing on the disease-resistant trend, such as promoting sweating to release the exterior in exterior syndrome, emesis, resolution and purgation methods used to discharge retained turbid pathogen in stomach and intestines. In a word, TCM therapy achieve the goal of “cure disease” through the method of “cure body”.Under the guidance of TCM theory, we generally don’t apply exogenous hormone in the treatment of asthma. At the stage of asthma episodes, we adopt the method of diffusing the lung to resolve phlegm and to calm panting, mainly focusing on the lungs, to relieve asthma symptoms quickly. As the asthma relieved, we adopt the method of fortifying the spleen, tonifying the kidney and resolving phlegm to dispel phlegm evil in the patients body, to prevent asthma relapse, and to restore the dynamic equilibrium between Yin and Yang among the viscera, added with dietary regulating,such as Yang deficiency patients avoid eating raw or cold food, lessen greasy food, Yin deficiency patients avoid eating spicy food ect. All this formed the whole treatment under the guidance of the holistic concept. While Western medicine treatment is very different from TCM therapy in the consistent application of hormone to resist airway inflammation all the year round or Montelukast to antagonize leukotriene receptor.
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3
Conclusion
The book Plain Questions says “man exists on the dependence of Tianqi (Heaven-Qi) and Diqi (Earth-Qi) and lives in accordance with the principle of the four seasons” and “for those who can abide the changes of the four seasons, the heavens and the earth are their parents”. The concept of holism in TCM emphasizes the coordination between intrinsic and extrinsic. The idea of correspondence between man and nature is the best interpretation and reflection of holism. Man is in correspondence with nature, so that man should adapt to changes in the nature physiologically, and conform to the nature in treatment. All this aims to achieve harmony and unity with nature. As one of the characteristics of the theoretical system of TCM, The concept of holism is based on the whole to understand the interdependent and harmony relationship of life between the internal and external environment, to explore the law of disease occurrence and development as well as the diagnosis and treatment. It is a concrete manifestation of the classical Chinese materialism and dialectics in TCM.
References
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1
LiuYanchi, Lei Shunqun. basic theories of Traditional Chinese medicine [M] Beijing: Macmillan press, 2005 2 Huang Guijin. Understanding of the concept of holism [J]. Journal of chengdu college of traditional Chinese medicine, 1982
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm Susanne Hiekel (Universität Duisburg-Essen, Institut für Philosophie)
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1
Heilkunde ohne Alternativen?
Die Medizin hat sich in der abendländischen Tradition in eine bestimmte Richtung entwickelt, die häufig unter den Begriff Schulmedizin gefasst wird. Historisch gesehen wird der Begriff in der Auseinandersetzung der Vertreter verschiedener Heilansätze im 19. Jh. in der homöopathischen Tradition mit pejorativen Gestus gegenüber anderen Heilansätzen geprägt, wird aber dann von den Vertretern einer naturwissenschaftlich orientierten Medizin für die eigene Position übernommen.1 Wie der Name Schulmedizin vermuten lässt, wird hierunter eine Medizin gefasst, die in (abendländischen) Schulen/Universitäten organisiert ist und gelehrt wird, die in die naturwissenschaftliche Landschaft eingebunden und selber auch den Anspruch der Wissenschaftlichkeit erfüllt. Die Anbindung an die Erkenntnisse der Naturwissenschaften und der eigene Anspruch der Wissenschaftlichkeit ist es, was aus schulmedizinischer Sicht den großen Vorteil dieser medizinischen Richtung gegenüber anderen Ansätzen ausmacht. Gegenüber anderen Ansätzen wird die Überlegenheit der Schulmedizin darüber gerechtfertigt, dass sie ihre Ansätze und Methoden einer kritischen Prüfung unterzieht, was den alternativen Heilansätzen angeblich nicht zueigen ist. Diese wiederum argumentieren häufig dagegen, dass nicht die kritische Überprüfung, dasjenige
1
Vgl. Robert Jütte. Von den medizinischen Sekten des 19. Jahrhunderts zu den unkonventionellen Richtungen von heute – Anmerkungen eines Medizinhistorikers. http://web.archive.org/web/20070315133549/http://www.bildung-mv.de/download/tagu ngsberichte/Juette-Vortrag.pdf. Zugriff 12.11.2012
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Susanne Hiekel
ist, was den Ausschlag hinsichtlich der Überlegenheit ausmacht sondern, dass derjenige Recht hat, der Heilerfolge aufweisen kann. Prima Facie scheint diejenige Position im Vorteil zu sein, die beide Elemente für sich verbuchen kann: Kritische Überprüfung und Heilerfolge. Hier kann die Schulmedizin in etlichen Krankheitsbildern punkten, denn die schulmedizinischen Heilansätze sind von vornherein als „allgemein anerkannte medizinische Praxis“ geprüft und es gibt z. T. hervorragende Heilerfolge insbesondere bei Infektionskrankheiten oder bei Behandlung von Vergiftungen u. a. Es würde sich praktisch kaum ein Problem stellen, wenn die Schulmedizin auf alle Probleme eine Lösung bieten würde. Das ist aber nicht der Fall. In vielen Fällen kann nur eine symptomatische Behandlung erfolgen (z. B. Senkung des Blutdrucks, ohne die Ursache des erhöhten Blutdrucks identifizieren und/oder heilen zu können). Zu manchen Symptomkomplexen kann sogar gar kein schulmedizinisches Krankheitsbild identifiziert werden. So zeigt sich z. B. in einer Studie, dass bei der Mehrheit von Patienten (90%), die eine allgemeinärztliche Praxis mit häufigen körperlichen Beschwerden aufsuchen (z. B. mit Kopfschmerzen, Müdigkeit, Thoraxschmerzen, Rückenschmerzen u. ä.), keine körperlich objektivierbaren (messbaren) Befunde festgestellt wurden, die diese Beschwerden ausreichend erklären könnten.2 Auch konnte bei symptomlosen Probanden – die sich also subjektiv als gesund bezeichnen würden – in mehreren Studien gezeigt werden, dass diese pathologische Befunde aufwiesen – objektiv also eher zu den Kranken gehören sollten.3 Die Schulmedizin stößt also praktisch und theoretisch an Grenzen und es stellt sich die Frage, ob nicht andere Heilmethoden in ein gesellschaftliches Gesundheitssystem Einzug halten sollten. Auch wenn diese Überlegungen von Schulmedizinern und vom Gesundheitssystem z. T. positiv beantwortet werden, wird meist darauf plädiert, dass genau die Elemente der alternativen Angebote in die Schulmedizin integriert werden sollten, die dem naturwissenschaftlichen Experiment und Nachweis zugänglich sind. Es werden dann quasi Bestandteile der Alternativmedizin, die sich in den schulmedizinischen Kontext einpassen lassen, inkorporiert. 4 Der 2 Vgl. Henry Johannes Greten. Kursbuch Traditionelle Chienesische Medizin. TCM verstehen und richtig anwenden. (Stuttgart: Thieme, 2007) S. 13 Vgl. auch Kroenke und Mengeldorff, American Journal of Medicine, 1989 3 Vgl. Henry Johannes Greten. Kursbuch Traditionelle Chienesische Medizin. TCM verstehen und richtig anwenden. (Stuttgart: Thieme, 2007) S. 13 4 So werden z. B. bestimmte in chinesischen Rezepturen gefundene Agenzien isoliert und
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
Rest der Alternativmedizin wird dann oft als ‚Hokuspokus‘ abgetan. Es stellt sich allerdings die Frage ob der Alternativmedizin eine genuine Daseinsberechtigung zukommt. Anhand eines bestimmten alternativen Angebots – der chinesischen Medizin – soll dies im Folgenden überlegt werden.
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2
Traditionelle Chinesische Medizin
Von der chinesischen Medizin ist im abendländisch geprägten Raum meist nur der die Schulmedizin ergänzende Aspekt der Akupunktur bekannt. Weniger bekannt ist, dass die Akupunktur nur eine Säule der chinesischen Medizin darstellt, die aus einem komplexen System herausgelöst wurde.5 Während man also häufig im abendländischen Lebensraum auf Ärzte trifft, die eine Akupunktur-Zusatzausbildung gemacht haben, und die dort erlangten Kenntnisse zusätzlich und ergänzend in ihrer Praxis anbieten, ist die volle Ausbildung zu einem Therapeuten in chinesischer Medizin an chinesischen Hochschulen mit einem Studium verbunden, dass in der Anzahl der Unterrichtsstunden der abendländischen Ausbildung eines Arztes gleicht. Dieser Unterricht beinhaltet sowohl die Lehre der theoretischen Grundlagen als auch deren klinischer Anwendung. Im Weiteren erfolgt eine abrisshafte Darstellung der Grundlagen der Chinesischen Medizin, die nicht den Anspruch der Vollständigkeit erhebt sondern bestimmte Charakteristika darlegt, um ein grobes Verständnis dessen, worum es in der Chinesischen Medizin eigentlich geht, herzustellen.
2.1 Theoretische Grundlagen Hinweise auf Verfahren, wie sie in der chinesischen Medizin angewendet werden, findet man bereits im 3. Jahrtausend v. Chr. (Steinsplitternadeln, die bei der Akupunktur Einsatz finden könnten). Ihren verschriftlichten Ursprung nimmt als wirksam in einer bestimmten Hinsicht in die schulmedizinische Arzneimittellehre aufgenommen. 5 Nach Greten sind die rein symptomatischen Akupunktur-Ausbildungsprogramme, die im Westen in großer Mode sind, eher der Ausbildung von chinesischen Arbeitern mit medizinischen Zusatzkenntnissen entsprechend – im Status mit Gemeindeschwestern / -helfern vergleichbar. Vgl. Henry Johannes Greten. Kursbuch Traditionelle Chienesische Medizin. TCM verstehen und richtig anwenden. (Stuttgart: Thieme, 2007) S. 8
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Susanne Hiekel
die chinesische Medizin im 3. Jh. v. Chr. Mit dem Huangdi Neijing (Buch des gelben Kaisers zur inneren Medizin) werden die Grundlagen niedergelegt, die in folgenden Werken der chinesischen Medizin weiterentwickelt und ergänzt werden. Neben den diagnostischen und therapeutischen Elementen werden grundlegenden Präsuppositionen in diesen Werken dargestellt. Diese Werke bilden also den theoretischen Ausgangspunkt der chinesischen Medizin, da sie die elementaren naturphilosophischen Überlegungen bereitstellen, auf denen die Medizin fußt. Während die Schulmedizin eine Welt präsupponiert, die in kleinste (natürliche) Teile zerlegt werden kann und die Dinge in der Welt mechanistisch interpretiert werden, setzt die chinesische Medizin voraus, dass die Welt und damit auch der Mensch nach Aspekten von Kräften bzw. nach Funktionskreisen zu betrachten ist. Diese chinesische Sicht der Welt ist vor allem durch die taoistische Traditionslinie zutiefst prozesshaft geprägt und konzeptualisiert die Naturgegenstände nach Veränderungsmustern. Ein wichtiger Aspekt ist dabei die Bestimmung der Dinge nach den Qualitäten von Yin und Yang. Yin und Yang sind grundlegende Aspekte, nach denen sowohl der Mikrokosmos (z. B. der Mensch) als auch der Makrokosmos (die Welt) qualifiziert werden und nach denen eine Klassifikation der Welt bzw. ihrer Dinge vorgenommen wird. Sie werden als gegensätzliche Pole von Aktivitäten konzeptualisiert: das Yin repräsentiert „beispielsweise all die Aspekte, die als ruhend, konkretisierend, erstarrend, verdichtend, oder vollendend charakterisiert werden können, Yang verkörpert hingegen die auslösende, beginnende, bewegende, verwandelnde, sich entfaltende aber auch auflösende und zerstreuende Wirkkraft.“6 Dementsprechend werden Dinge der Welt – und eben auch der Mensch – nach ihrer Yin und ihrer Yang-Qualität geordnet und in einen Erklärungszusammenhang gebracht. Yin und Yang dienen also dazu prozesshaftes Geschehen – Muster von Veränderungen – zu beschreiben und zu erklären. Ein für den Menschen anzustrebender Gesamtzustand wird als derjenige beschrieben, bei dem sich Yin und Yang in einem Gleichgewicht befinden. Mögliche Krankheitssymptome werden auf ein Ungleichgewicht zurückgeführt, dass behoben werden soll. Dieser formale Gesichtspunkt wird inhaltliche durch die Kriterien angereichert, anhand derer man die Zuschreibung von Yin und Yang 6
Dominique Hertzer. Das Leuchten des Geistes und die Erkenntnis der Seele. Die medizinische Vorstellung vom Seelischen als Ausdruck philosophischen Denkens – China und das Abendland. (Bad Homburg: VAS, 2006)S. 214
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
vollführt. Ein essentieller Bestandteil der Elemente, die in dieser Hinsicht beurteilt werden ist u. a. das Qi7, welches durch die chinesischen Gesundheitsübungen (Qi Gong) manchem geläufig aber doch meist unter dem Occamschen Verdacht steht, die Dinge der Welt unnötigerweise zu vervielfältigen.8 Das Qi wird häufig mit Energie übersetzt9 und signalisiert damit – gegenüber der auch geläufigen Übersetzung Lebenskraft –, dass sowohl Unbelebtes als auch Belebtes über Qi verfügt bzw. aus Qi besteht. Es wird allerdings im chinesischen Denken nicht versucht das Qi materiell zu referentialisieren, sondern die Charakterisierung dessen, was unter Qi zu verstehen ist, erfolgt funktional. Beim Menschen sind folgende Funktionen mit dem Ausdruck ‚Qi‘ bezeichnet: Quelle aller Bewegung im Körper, Begleitung jeder Bewegung, Schutz des Körpers, Quelle harmonischer Transformation im Körper, Regelung der Bewahrung von Körpersubstanzen und Organen, Wärmung des Körpers. 10 Es wird also angenommen, dass ohne Qi keine Bewegung möglich ist, der Körper nicht geschützt werden kann, keine harmonischen Transformationen im Körper geschehen können, die Körpersubstanzen nicht bewahrt werden können und der Körper nicht warm gehalten werden kann. Man könnte hier von einem Sammelbegriff sprechen, der unterschiedliche phänomenale Komponenten, die für ein gesundes (harmonisches) Leben notwendig sind, zusammenfasst. Der Körper des Menschen wird als eine Art Gefäß vorgestellt, in dem das Qi sich entfaltet. Es werden drei Quellen des Qi unterschieden: das vorgeburtliche Qi, das von den Eltern auf das Kind übertragen wird, das Nahrungs-Qi, das über die Nahrung aufgenommen wird und das Natürliche-Luft-Qi, das über die eingeatmete Luft gewonnen wird. „Diese drei Formen von Qi vermischen sich und produzieren das Normale Qi, das den ganzen Körper erfüllt.“11 Während
7
Im Weiteren beschränken sich die Überlegungen auf die Annahme des Qi und andere Elemente, die in der chinesischen Medizin eine Rolle spielen (Xue (Blut), Jing (Essenz), Shen (Geist), die fünf Wandlungsphasen etc.) werden nicht erwähnt. 8 Vgl. hierzu Kapitel 3. 9 Bei den Übersetzungen chinesischer Ausdrücke ist darauf zu achten, dass die übliche Bedeutung der Ausdrücke chinesisch konnotiert sind, d. h. sie haben nicht genau die Bedeutung, die man ihnen im abendländischen Gebrauch zusprechen würde, da sie in eine chinesisch geprägte Gedankenwelt kontextualisiert sind. 10 Vgl. Ted. J. Kaptchuk. Das große Buch der chinesischen Medizin. Die Theorie von Yin und Yang in Theorie und Praxis. (Bern, München, Wien: Barth, 1993) S. 48f 11 Ted J. Kaptchuk. Das große Buch der chinesischen Medizin. Die Medizin von Yin und Yang in Theorie und Praxis. (Wien: Barth, 1993) S. 47
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Susanne Hiekel
man das vorgeburtliche Qi bestenfalls über Empfehlungen in der Schwangerschaft für beeinflussbar hält, werden das Nahrungs-Qi und das Natürliche-Luft-Qi über Empfehlungen bzgl. der Lebensführung (Ernährungsempfehlungen / Atemübungen) direkt zu beeinflussen versucht. Es wird angenommen, dass das Normale Qi den menschlichen Körper in Leitbahnen (Meridianen) durchströmt, was die Grundlage der Akupunktur darstellt. Diese Leitbahnen werden bestimmten Funktionskreisen zugeordnet, so dass über die Manipulation der Leitbahnen bzw. deren Reizpunkte Einfluss auf den Funktionskreis genommen werden kann. Die Funktionskreise gehören zur strukturierenden Basis der Diagnosestellung. Die Benennung der Funktionskreise orientiert sich größtenteils an organischen Strukturen12, aber sie referieren nicht auf die substrathaften Organe sondern eher auf funktionale Äußerungen verschiedenen Körperbereiche.13 Anders als man es gewöhnt ist, fallen also z. B. unter den Funktionskreis der Leber nicht die Synthese von Bluteiweißen etc. sondern unter dem Leber-Funktionskreis wird die gleichmäßige fließende Bewegung von körperlichen Substanzen, die Regelmäßigkeit körperlicher Aktivitäten aber auch die Herstellung eines harmonischen Gemütszustandes zusammengefasst. Jede Beeinträchtigung des Leber-Funktionskreises führt zur Beeinflussung der Bewegung der Körpersäfte und damit zu Stauungen und zur Stagnation, auf der emotionalen Seite zu Ärger und Enttäuschung. Die Beeinträchtigung wirkt sich phänomenal aus und ist so diagnostizierbar (z. B.: Muskelspasmen, Taubheit der Extremitäten und Schwierigkeiten beim Beugen und Strecken, trocken Augen, brüchige blasse Nägel). Es handelt sich also bei den Funktionskreisen eher um „konventionell fixierte Definitionen von Wirkbeziehungen (= Funktionen) und nicht lediglich [um] die Umschreibung rudimentär anatomischer Erkenntnisse.“14 Die harmonische Qi-Konstellation in und zwischen den Funktionskreisen wird als ein gesunder Zustand angesehen. Ist jedoch einer der Funktionskreise mit zu viel/zu wenig Qi oder insgesamt das ganze Individuum mit zu wenig Qi ausgestattet, kommt es zur Disharmonie und damit zu einem Zustand der behandlungsbedürftig ist. Dieser Zustand muss nicht im westlichen Sinne mit einem Zustand 12
Funktionskreise: Leber-, Herz-, Milz-, Lunge-, Niere-, Herzbeutel-, Galle-, Dünndarm-, Magen-, Dickdarm-, Blase-, Dreifacher Erwärmer-Funktionskreis. Dem Funktionskreis des dreifachen Erwärmers kann kein Organ der Schulmedizin zugeordnet werden. 13 Vgl. M. Porkert. S. 88. 14 M. Porkert S. 88.
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
des Krankseins zusammenfallen. Die chinesische Medizin ist präventiv ausgerichtet und versucht ein Ungleichgewicht der Kräfte im Ansatz zu behandeln, so dass es zu einem manifesten westlichen Krankheitsbild gar nicht erst kommen kann. Diese gesamte Auffassung erscheint befremdlich, denn im abendländischen Raum ist man vielfach daran gewöhnt die materielle Basis von Funktionszuschreibungen zu suchen. In der chinesischen Auffassung spielt diese Überlegung allerdings kaum eine Rolle. Hier wird nicht primär versucht ein bestimmtes Substrat ausfindig zu machen, sondern es werden die funktionalen Aktivitäten fokussiert und mit den korrespondierenden Phänomenen korreliert. Diese Korrelation steht natürlich unter einem Willkürlichkeitsverdacht – ähnlich der Koinzidenz der Storchhäufigkeit mit der Geburtenhäufigkeit. Allerdings ist hier anzumerken, dass anders als bei Störchen und Kindern unter der Beschreibung der ineinander wirkenden Funktionskreise eine wirkmächtige Praxis entstanden ist. Zugegebenermaßen ist diese Praxis nicht in allen Belangen wirkmächtig. So kann die chinesische Medizin z. B. die Erkrankungen, die wir unter die Infektionskrankheiten fassen, oder notfallmedizinische Situationen nicht sehr gut behandeln, aber es gibt weite Bereiche, in denen sie sehr gut funktioniert.15
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2.2 Die Praxis Sowohl im Diagnoseverfahren als auch in den Methoden der Therapie unterscheidet sich die chinesische Medizin sehr stark von denen der Schulmedizin.
15
Vgl. z. B.: Acupuncture for paroxysmal and persistent atrial fibrillation: An effective non-pharmacological tool?, World J Cardiol, 26 März 2012, 4(3), 60-65. Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis – a patient- and examiner-blinded,randomized, placebo-controlled, crossover trial, Allergy, April 2012, 67(4), 566-73). A systematic review on use of Chinese medicine and acupuncture for treatment of obesity, Obes Rev, Mai 2012, 13(5), 409-430. Acupuncture for the treatment of severe acute pain in Herpes Zoster: results of a nested, open-label, randomized trial in the VZV pain study, BMC Complementary and Alternative Medicine, 2011, http://www.biomedcentral.com/1472-6882/11/46.
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Susanne Hiekel
2.2.1 Diagnose
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Das diagnostische Verfahren setzt sich aus vier Elementen zusammen: 1. Visuelle Betrachtung des Patienten (Statur, Bewegung, Zunge) 2. Akustische und olfaktorische Beurteilung (Klang und Festigkeit der Stimme, Art der Atmung, Körpergeruch), 3. Befragung des Patienten (Temperaturempfinden, Schwitzneigung, Besserung oder Verschlechterung nach dem Genuss bestimmter Nahrungsmittel, Beeinflussungsfaktoren des Befindens, Appetit, Ausscheidungsbeurteilung, Funktionstüchtigkeit der Sinnesorgane etc.) und 4. palpatorische Beurteilung (Pulstastung, mit Beurteilung der Pulsqualität). Diese gesamte phänomenale Befunderhebung wird dann zur Diagnosestellung verwendet. Auf den ersten Blick scheint dieses Verfahren nur eine abgeschwächte oder vielleicht zu ausführliche Anamneseerhebung eines schulmedizinischen Diagnoseverfahrens darzustellen, wichtig ist hier aber die Einordnung in den entsprechenden theoretischen Rahmen der chinesischen Medizin: Die westliche Medizin ist hauptsächlich mit isolierbaren Krankheitskategorien oder -ursachen beschäftigt, die sie herausgreift und zu ändern, zu kontrollieren oder auszuschalten versucht. Der westliche Arzt fängt mit einem Symptom an und sucht dann nach dem zugrunde liegenden Mechanismus – einer präzisen Ursache für eine spezielle Krankheit. Die Krankheit mag verschiedene Teile des Körpers in Mitleidenschaft ziehen, stellt jedoch ein ziemlich klar definiertes, in sich geschlossenes Phänomen dar. […] Der chinesische Arzt hingegen richtet seine Aufmerksamkeit auf das gesamte physiologische und psychologische Individuum. Alle relevanten Informationen, einschließlich der Symptome und generellen Charakteristika des Patienten, werden gesammelt und zusammengewoben, bis das, was die Chinesen ein »Muster der Disharmonie« nennen, erkennbar wird. Dieses Disharmoniemuster beschreibt eine Situation des »Ungleichgewichts« im Körper des Patienten. […] Die Gesamtkonfiguration – das jeweilige Disharmoniemuster – stellt den Rahmen der Behandlung dar. Die Therapie versucht, die Konfiguration ins Gleichgewicht zu bringen, die Harmonie im Individuum wiederherzustellen.16
Diese Unterscheidung von westlicher und östlicher Medizin ist zugegebenermaßen sehr grob und nicht jeder westliche Mediziner mag sich so charakterisiert wiederfinden, dennoch ist die Unterscheidung klar: der westliche Mediziner 16
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Ted J. Kaptchuk. S. 15.
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
versucht aus den genannten Symptomen und nach Messung verschiedener Parameter ein Krankheitsbild zu identifizieren, zu dem einige – aber evtl. nicht alle – Aspekte der Befunderhebung passen. In einem Sinne ist er daher nicht weniger holistisch, denn er fokussiert das Ganze des bestimmten Krankheitsbildes und ordnet dementsprechend bestimmte Bausteine des Symptomangebotes zu – nichtsdestoweniger konzentriert er sich auf einen bestimmten zu einem Krankheitsbild passenden Teil der Symptome und damit auf einen Teil des Patienten. Sein Vorgehen ist dabei analytisch: er nimmt das Ganze (das Krankheitsbild) für gegeben und analysiert auf dessen mögliche Bestandteile hin. Der chinesische Mediziner versucht hingegen das ganze genannte und diagnostizierte Symptomspektrum in ein Bild zu bekommen und qualifiziert daran den Zustand des Patienten. Sein Vorgehen wird als induktiv synthetisch beschrieben: eine großzügige Berücksichtigung alles Erfassbaren anhand der ordnenden Strukturen (Yin und Yang, Funktionskreise, Qi, etc.).17 Hier wird schon ein Element deutlich, warum die Schulmedizin dem Anspruch der Nachprüfbarkeit eher standhält. Anhand der Krankheitsbilder können eine Großzahl von Patienten zusammengefasst und typisiert werden, bei der individuellen Beurteilung ist dies schwerer möglich. Nichtsdestoweniger findet eine Typisierung statt, denn ansonsten wäre eine Diagnosestellung gar nicht möglich, die Diagnose kann nur in der chinesischen Medizin schwerer vom individuellen Menschen abgelöst werden. In einem Sinne ähneln die Diagnosestellungen natürlich den westlichen Krankheitsbildern, da sie dem Arzt anzeigen, welche Behandlung angezeigt ist. Andererseits ist die Diagnose abhängig vom ganzen Erscheinungsbild des Patienten und kann nicht losgelöst vom Patienten erstellt werden.18 So finden sich z. B. unter sechs Patienten, bei denen allesamt unter schulmedizinischer Diagnostik ein Magengeschwür festgestellt wurde, unter chinesischer Sicht sechs verschiedene Disharmoniemuster, die zu sechs unterschiedlichen Behandlungsformen führen.19 In folgender Tabelle sind drei dieser sechs Erhebungen charakterisiert, so dass die unterschiedlichen Disharmoniemuster vor Augen geführt werden. 17
Vgl. Carl-Hermann Hempen. Die Medizin der Chinesen. Erfahrung mit fernöstlicher Heilkunst. (München: Goldmann, 1991) S. 56. 18 Vgl. Ted J. Kaptchuk. S. 18 Eine Trennung von geistig/seelischem und körperlichen Symptomen kennt die chinesische Medizin nicht. 19 Vgl. Ted J. Kaptchuk. 16.
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Susanne Hiekel Tab. 1. Befunderhebung und Diagnose dreier Patienten mit der schulmedizinischen Diagnose ‚Magengeschwür‘20
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Befragung
Patient 1
- Schmerz, der sich durch Berührung verschlimmert - leidet unter Verstopfung - Urin dunkelgelb
Patient 2
- fortwährender Durst - Tendenz zur Verstopfung - Schlaflosigkeit - Nachtschweiß
Patient 3
20
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- ständiges leichtes Unbehagen - Linderung der Schmerzen durch Massage/Wärme - Nahrungsaufnahme führt kurzzeitig zu Schmerzbefreiung - Abneigung gegen Kälte - spontane Schweißausbrüche
Aussehen Klang Geruch - robuste Konstitution - rötlicher Teint - Auftreten bestimmt, aggressiv - volle tiefe Stimme - dünn - aschgrauer Teint, Wangen rot - nervös unruhig - mit sich selbst unzufrieden - Zunge trocken, leicht rot, ohne Belag
- schüchtern, fast ängstlich, - Zunge feucht, blass
Puls
Diagnose
- voll und drahtig
- feuchte Hitze, die die Milz befällt
- fein, ein wenig schnell
- mangelndes Yin, das den Magen beeinträchtigt
- leer
- erschöpftes Feuer des Mittleren Erwärmers
Vgl. Ted J. Kaptchuk. S. 16f.
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
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- großes Schlafbedürfnis - Urin klar, häufiges urinieren - unfähig sich durchzusetzen
Die unterschiedlichen metaphysischen Perspektive des Westens und des Ostens schlagen sich in dieser Art der Diagnosestellung nieder. Die westliche Sicht ist analytisch geprägt und auf der Suche nach dem, was als gegenständliche Ursache hinter den Phänomenen angenommen werden sollte. Bei den Magengeschwüren wäre dies z. B. die Rückführung der Symptomatik auf den Befall mit dem Bakterium Helicobacter pylori. Den Vorteil, den die westliche Perspektive hier hat ist, dass diese Art der Metaphysik in der abendländischen Philosophie sehr gut ausgearbeitet ist. Auch prozesshaftes Geschehen kann unter dieser Methodik verständlich gemacht werden, wie es Aristoteles in der Physik vorgelegt hat und in der heutigen Zeit von denjenigen Philosophen, die endurantistische Positionen ausgearbeitet haben (z. B. Peter Simons, PJM Hacker, Marianne Schark), weiter analysiert wird. Eine Sichtweise, wie die der Chinesen, bei der ein prozesshaftes Geschehen unterstellt wird, und dies weitestgehend ohne die Annahmen von Substraten verständlich gemacht wird, ist in der abendländischen Philosophie demgegenüber wenig ausgearbeitet. Es finden sich aber einige wenige Ansätze. Ähnliche Gedankengänge finden sich im Abendland z. B. beim Vorsokratiker Heraklit und sehr viel später bei Whitehead. In neuerer Zeit werden noch andere Konzeptionen von denjenigen Philosophen, die sogenannte perdurantistische Positionen ausarbeiten, vorgelegt.1 Diese Konzeptionen bedürfen selber der weiteren philosophischen Untersuchung und ein Konnex, wenn es einen gibt, zwischen dem aristotelischen und dem heraklitschen Lager muss erst noch herausgearbeitet werden.
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2.2.2 Therapie Die, aufgrund der verschiedenen Diagnosen, in Anschlag zu bringenden Therapiemöglichkeiten erstrecken sich nicht wie allgemein angenommen wird auf die Akupunktur. Die alleinige Eingliederung der Akupunkturmethode in den schulmedizinischen Alltag ist, so sollte es hoffentlich bis hierher klar geworden sein, eher von fragwürdiger Natur. Ohne die entsprechende chinesische Diagnose und die damit einhergehende Anbindung an entsprechende Funktionskreise ist die Akupunktur losgelöst aus dem Kontext, aus dem sie sinnhaft erscheint und bleibt daher unter ihren Möglichkeiten. Die Herangehensweise muss vielmehr folgendermaßen erfolgen: Die chinesische Medizin beginnt mit der Formulierung einer chinesischen Diagnose, das heißt, Klarheit darüber zu verschaffen, welche funktionellen Störungen, welche energetischen Entgleisungen beim jeweiligen Patienten vorliegen. Der zweite Schritt für den Arzt ist, für dies individuell geformte Schloß den passenden therapeutischen Schlüssel zu finden, und dieser kann nur dann gefunden werden, wenn das therapeutische Instrumentarium analog gestaltet ist.21
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Zu diesem Instrumentarium, die gegebenenfalls einzeln oder zusammen den therapeutischen Schlüssel im Schloss der chinesischen Diagnose darstellen, gehören folgende Elemente: 1. Chinesische Arzneimittel 2. Akupunktur / Moxibustion 3. Tuina (chinesische Massage) 4. Diätetik 5. Qi Gong (Gesundheitsübungen) 2.2.2.1 Chinesische Arzneimittel Ebenso, wie die Diagnosestellungen auf dem chinesischen Theoriegebäude beruhen, sind auch die Therapieverfahren und damit auch die chinesische Arzneimittellehre von diesem Fundament aus entwickelt worden. Die Typisierung der 21
Carl-Hermann Hempen. Die Medizin der Chinesen. Erfahrungen mit fernöstlicher Heilkunst. (München: Goldmann, 1991) S. 105f.
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
Arzneimittel der Schulmedizin erfolgt anhand ihrer chemischen Zusammensetzung, ihrer physikalischen Eigenschaften und ihrer Pharmakodynamik. „Diese Informationen sind zum größten Teil losgelöst vom Menschen im Laboratorium, in vitro, ermittelt worden. Gesucht wird in der Regel ein spezifischer Organbezug und an diesem eine spezifische Wirkungsweise.”22 Dies entspricht ganz dem schulmedizinischen Forschungsparadigma und hat große Erfolge zu verzeichnen. Die chinesischen Arzneimittel werden hingegen auf ihre direkte Wirkung auf den Menschen hin typisiert. Es wird hinsichtlich der -
-
wärmenden oder kühlenden Eigenschaften (Temperaturverhalten) der Geschmacksrichtung (scharf, süß, sauer, bitter, salzig), Wirkung (Lösung / Mobilisierung von Energie, Ausgleichung / Regulierung / Pufferung / Spendung von Energie, Adstringierung von Energie, Trocknung/Dämpfung von Energie, Erweckung / Befeuchtung / Laxierung von Energie) und der Zuordnung zu einem Funktionskreis
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klassifiziert. Aus diesen Angaben kann dann ein Wirkprofil der Arzneimittel erstellt werden, dass durch klinische Beobachtungen ergänzt wird.23 So ist z. B. der frische Ingwer, der als ein Arzneimittel angesehen wird, durch folgendes Wirkprofil charakterisiert: [S]ein Temperaturverhalten sei neutral bis leicht warm, seine Geschmacksrichtung scharf und er wirke in erster Linie auf den Funktionsbereich »Lunge«, aber auch auf die gesamte »Mitte«. […] Die Oberfläche wird gelöst, der Ingwer wirkt schweißtreibend. Die »Mitte« wird erwärmt. […] Ingwer stillt Übelkeit, hebt den Hustenreiz auf, außerdem wird Schleim ausgeleitet.24
Charakterisierungen solcher Art der verschiedensten Heilkräuter25 beruhen auf der Beobachtung von Wirkungen der Mittel über mindestens 2000 Jahre hinweg. Sie sind also rein phänomenal gestützte empirische, sozusagen im ‚Menschenex22
A.a.O. S. 121. Vgl. A.a.O. S. 117f. 24 A.a.O. S. 118. 25 1984 waren am College für Traditionelle Chinesische Medizin in Chengdu über 3000 Arzneimittelspezialitäten vorhanden. Zu den verwendeten Kräutern zählen auch im europäischen Bereich bekannte Pflanzen wie z. B. Knoblauch, Mandel, Spargel, Zimt, Chrysantheme, Ginsengwurzel, Süßholzwurzel, Walnuss, Leinsamen, Minze, Pfingstrose etc. Vgl. A.a.O. S. 113. 23
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periment‘ angefertigte, Charakterisierungen. Im 20. Jahrhundert werden zwar zusätzlich zu der traditionellen Charakterisierung auch aktive Verbindungen und biochemische Parameter mit hinzugenommen,26 die Therapietauglichkeit wird aber anhand des traditionellen Wirkprofils ermittelt. Die schulmedizinische Charakterisierung verschiedener Substanzen ist hilfreich indem z. B. eine schulmedizinische Indikation oder schädigende Substanzen ermittelt werden können, es können auch aus schulmedizinischer Sicht gebotene Höchstgrenzen der Darreichung formuliert werden. Der Behandlung aus chinesischer Sicht dienen sie hingegen primär nicht, da sie nicht in den Theorierahmen passen. Zur Therapie werden selten Einzelmittel verwendet. Meist werden Heilkräutermixturen verschrieben, die dem komplexen Diagnosebild Rechnung tragen. Aus den Kräutern27 wird meist ein Absud angefertigt (Dekokt), der über den Tag verteilt getrunken werden muss. Es werden aber auch Pillen, Salben, Tinkturen, Breiumschläge und Sirupe hergestellt.
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2.2.2.2 Akupunktur / Moxibustion Ergänzt wird die Arzneimittelbehandlung durch die schon mehrfach erwähnte Akupunktur. Die Grundlage der Akupunktur liefert die Annahme, dass das Qi auf Leitbahnen (Meridianen) durch den Körper fließt28 und über die Leitbahnen bzw. deren Reizpunkte beeinflussbar ist. Bestimmte Reizpunkte bzw. deren Verknüpfung (Leitbahnen) sind den Funktionskreisen zugeordnet, so dass dieser Konnex therapeutisch ausgenutzt werden kann. Wird z. B. eine Störung des Leber-Funktionskreises diagnostiziert, so werden entsprechend bestimmte Punkte auf der Leber-Leitbahn entweder über Nadeln (Akupunktur) oder durch lokale Wärmebehandlung (Moxibustion) behandelt. Die Nadeln dienen vornehmlich der Ableitung von zu viel Energie, das Erwärmen durch Verbrennen von Beifußkraut am Reizpunkt wird für die Zuführung von Energie verwendet. 26
Vgl. Ted J. Laptchuk. S. 95. Die ebenfalls in der chinesischen Arzneimittellehre vorzufindenden Agenzien aus dem tierischen Bereich (z. B. Gallensteine einer Kuh, Sekret der Ohrspeicheldrüse einer bestimmt Kröte vgl. Kaptchuk S. 95) sind eher in der westlichen Sphäre bekannt und tragen dazu bei, dass die chinesischen Arzneimittel eher als Kuriositäten denn als wirksame Heilmittel gehandelt werden. 28 Dieses Fließen braucht nicht substrathaft gedacht werden, sondern kann eher metaphorisch verstanden werden. 27
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
Folgende Abbildung zeigt die Leber-Leitbahn und die auf ihr lokalisierten Reizpunkte.
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Abb. 2. Leber-Leitbahn aus Carl-Hermann Hempen. Die Medizin der Chinesen
Dass die Akupunktur erfolgreich medizinisch eingesetzt werden kann, wird durch viele Studien gezeigt, dennoch hält sich die Meinung, dass es sich lediglich um einen Placeboeffekt handelt. Für Aufruhr hat in letzter Zeit zudem eine Studie gesorgt, die zwar zu dem Ergebnis gekommen ist, dass die Akupunktur vergleichsweise sehr gute Ergebnisse bei der Behandlung bestimmter Krankheiten bietet (und auch bessere als die schulmedizinische Methode), dass aber die willkürliche Nadelung ohne Berücksichtigung der Leitbahnen (Sham-Akupunktur) zu ähnlichen Ergebnissen führt, wie die Nadelung an den Leitbahnen (Verum-Akupunktur). 29 Hier sind allerdings einige Zweifel angebracht, 30 da die beteiligten Ärzte angehalten waren routinemäßige Akupunkturen, die sich nach dem westlichen Krankheitsbild richteten, einzusetzen, was zur Folge hat, dass
29
Diese Ergebnisse wurden dann auch ziemlich beißend (‚Die eingebildete Heilung’) z. B. vom Spiegel publik gemacht. 30 Vgl.: http://www.akupunktur-qualitaet.info/infos_fuer_aerzte/index.shtmlgl. Zugriff 19.11.2012.
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die Verum-Akupunktur sehr wahrscheinlich nicht so wirksam war, wie sie es passend zu einer ‚chinesischen Diagnose‘ hätte sein können. Diesen Faktor verstärkt, dass die beteiligten Ärzte, die an der Studie teilgenommen haben, größtenteils nur eine Akupunktur-Grundausbildung besessen mit einem sogenannten A-Diplom (140-200 Fortbildungsstunden) haben und somit nicht als Spezialisten im Bereich der chinesischen Medizin angesehen werden können.31 Festzuhalten ist aus dieser Studie jedenfalls, dass die Akupunktur wirksam war und die Wirksamkeit bei der Behandlung von chronischen Knie- und Rückenschmerzen sogar doppelt so hoch war, wie bei der westlichen Standardtherapie.32 Das soll kein Plädoyer dafür sein, die chinesische Medizin in allen Fällen als das Mittel der Wahl anzusehen, sondern soll vielmehr für Benevolenz werben. Die Versuche, die Akupunktur über naturwissenschaftliche Methoden zugänglich zu machen (z. B. Nachweisversuche des Qi, Versuch des Nachweises der materiellen Basis der Leitbahnen), sind vielfältig, aber im Grunde für die Beurteilung der chinesischen Medizin irrelevant (ähnliches gilt auch für die anderen Therapieverfahren der Chinesischen Medizin), da ein naturwissenschaftlicher Beleg zwar Bestätigung bringt, allerdings bei einem Scheitern des Nachweisversuches die Nicht-Existenz wohl kaum ausgewiesen ist.
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2.2.2.3 Tuina Ähnlich wie die Akupunktur und die Moxibustion zielt die chinesische Massage darauf ab, Qi zu aktivieren, zu lösen und zu harmonisieren indem äußerlich auf den Menschen eingewirkt wird. Die Tuina-Behandlung wirkt durch die Beeinflussung von Reizpunkten, Muskeln und Bindegewebe mit den Händen. 33 Durch verschiedene manuelle Techniken wie z. B. Druck, Vibration, greifendes Kneten kann unterschiedlich (Energie ergänzend, Spasmen lösend, Qi bewegend) eingewirkt werden.34
31
Die Internationale Gesellschaft für Chinesische Medizin e. V. (Societas Medicinae Sinensis) bildet z. B. zertifizierte Mediziner in der chinesischen Medizin mit einem mindestens abzuleistenden Fortbildungsstundenkontingent von 1000 Stunden aus. 32 Vgl.: http://www.akupunktur-qualitaet.info/infos_fuer_aerzte/index.shtmlgl. Zugriff 19.11.2012. 33 Vgl. Henry Johannes Greten. Kursbuch Traditionelle Chinesische Medizin. S. 371. 34 Vgl. ebd.
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
2.2.2.4 Diätetik Wie die bisherigen Ausführungen vermuten lassen, sind die diätetischen Empfehlungen auf der Grundlage der chinesischen Medizin anders geartet, als die der schulmedizinisch basierten Ernährungslehre. Nach westlicher Meinung werden Empfehlungen aufgrund von bestimmten Bestandteilen der Nahrung (Kohlehydrate, Eiweiße, Fette, Vitamine, Spurenelemente) ausgesprochen. Dementgegen werden die Ratschläge hinsichtlich einer guten Ernährung in der chinesischen Medizin auf der Grundlage der gleichen Wirkspektren ausgesprochen, wie sie schon bei der Arzneimittellehre geschildert wurden (Temperaturverhalten, Geschmacksrichtung, Einfluss auf Funktionskreise). So wird z. B. bei einer Diagnose einer schwachen ‚Mitte‘ (Milz-Funktionskreis) angeraten, Nahrungsmittel zu sich zu nehmen, die tendenziell süß sind (z. B. Hirse). Über die Gestaltung der täglichen Ernährung wird Einfluss auf den Gesamtzustand des Menschen genommen. Eine Fehlernährung, die nicht zum individuellen Bedarf passt – also eine Disharmonie erzeugt –, beeinträchtigt die Gesundheit und ist dementsprechend über die Beachtung von Ernährungsempfehlungen zu vermeiden. In diesem Sinne sind Nahrungsmittel ähnlich wie Arzneimittel zu behandeln.
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2.2.2.5 Qi Gong Ähnlich wie bei dem Therapieaspekt der Diätetik, wird bei den Qi Gong-Empfehlungen der Patient aktiv mit in die Behandlung eingebunden. Er muss selber aktiv werden, um die diagnostizierte Disharmonie zu beseitigen – sei es in der Veränderung der Ernährungsgewohnheiten wie bei der Durchführung von bestimmten Übungen. Qi Gong heißt übersetzt ‚Arbeit am Qi‘ und umfasst sowohl körperliche (sogenannte äußere) wie auch Atem-, Konzentrations- und Aufmerksamkeitsübungen (innere Übungen). Während die ersteren ungefähr äußerlich dem entsprechen, was man hierzulande als Gymnastik bezeichnen würde, haben die inneren Übungen einen eher meditativen Charakter. Bei den äußeren Übungen geht es nicht darum, bestimmte Muskelgruppen oder das Kreislaufsystem zu trainieren. Die Grundüberlegung – wie sollte es auch anders sein – basiert wieder auf der Annahme des Qis und des Zirkulierens desselben durch den Körper. Ziel der körperlichen Übungen ist es, den freien
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Fluss des Qis durch den Körper zu ermöglichen. Dies wird dadurch erreicht, dass Positionen eingenommen werden, von denen man annimmt, dass diese dem Ziel förderlich sind. In der Grundposition ist dies eine entspannte, (aber nicht schlaffe) Haltung, bei der eine gute Struktur des Körpers erzielt wird, ohne dass Muskeln aktiv angespannt werden müssen. Aus dieser Position heraus werden verschiedenste Bewegungsabfolgen vollführt. Bei den inneren Übungen wird durch Konzentration auf bestimmte Körperareale / Leitbahnen bzw. deren Reizpunkte versucht ebenfalls das Qi zu aktivieren und zu mobilisieren. Sowohl die äußeren als auch die inneren Übungen führen zur Wahrnehmung, dass etwas im Körper fließt bzw. warm wird. So haben Anfänger in den Qi Gong Übungen häufig das Gefühl, dass z. B. die Hände warm werden und pulsieren. Diese Perzeptionen werden als das Fließen und Aktiv-Werden des Qi aufgefasst. Die Qi Gong Übungsreihen sind vielfältig und kaum zu überschauen. Bekannt sind hier bei den äußeren Übungen evtl. die Acht Brokate oder das Spiel der Fünf Tiere und bei den inneren Übungen der Kleine Energiekreislauf, welche zur allgemeinen Verbesserung der Gesundheit geübt werden. Es gibt aber auch Empfehlungen speziell in Hinblick auf spezielle Disharmonien.
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3
Chinesische Medizin – ein paralleles Forschungsprogramm?
Nach T. S. Kuhn arbeiten wissenschaftliche Disziplinen in der normalwissenschaftlichen Phase immer unter einem Forschungsparadigma; d.h. gebunden an eine normalwissenschaftliche Tradition. Normalwissenschaftlich wird immer dann geforscht, wenn zu bestimmten Erklärungsdesiderata bzgl. eines Phänomenbereichs erfolgreiche Strategien immer wieder Anwendung finden, so dass sowohl der Umfang der Erklärungen hinsichtlich des Phänomenbereichs zunimmt als auch das Paradigma weitere Ausformulierungen erfährt. Etwas spitz formuliert Kuhn: Bei näherer Untersuchung, sei sie historisch oder im modernen Labor, erscheint dieses Unternehmen [das der normalen Wissenschaft] als Versuch, die Natur in die vorgeformte und relativ starre Schublade, welche das Paradigma darstellt, hineinzuzwängen. […] Durch Konzentration der Aufmerksamkeit auf einen kleinen Bereich relativ esoterischer Probleme zwingt das Paradigma
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm die Wissenschaftler, ein Teilgebiet der Natur mit einer Genauigkeit und bis zu einer Tiefe zu untersuchen, die sonst unvorstellbar wären.35
Die Forschung unter einem Paradigma wird auch als das Lösen von Rätseln (‚puzzle solving‘) bezeichnet, wobei jedoch die Auswahl der Rätsel, die einer Lösung für zugänglich gehalten werden, von dem herrschenden Forschungsparadigma abhängt.
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In weitem Maße sind dies die einzigen Probleme, welche die Gemeinschaft als wissenschaftliche anerkennt oder welche in Angriff zu nehmen sie ihre Mitglieder ermutigt. Andere Probleme […] werden als metaphysisch abgelehnt, als Angelegenheit einer anderen Disziplin betrachtet oder manchmal einfach für zu problematisch gehalten, um die Zeit daran zu verschwenden.36
Übertragen auf die wissenschaftliche Disziplin der Medizin heißt das, dass auch diese im Westen unter einem Forschungsparadigma arbeitet, welches bestimmte Probleme einer Lösung für zugänglich erachtet und für deren Lösung ein bestimmtes Set an Lösungsstrategien für adäquat gehalten werden. Dieses Forschungsparadigma ist die sogenannte ‚Schulmedizin‘37, welche von denjenigen, die unter diesem Paradigma arbeiten, auch unter der Bezeichnung ‚evidenzbasierte Medizin‘ firmiert. Anhand der zuvor gemachten Ausführungen zu Theorie und Praxis der Chinesischen Medizin, ist nun zu überlegen, ob die Chinesische Medizin nicht auch ein Forschungsparadigma darstellt, unter dem parallel zur Schulmedizin mit dem gleichen Ziel (Krankheiten / Disharmonien zu vermeiden, zu therapieren oder zu kompensieren) geforscht wird. Der Vorschlag Poppers ist es, nur diejenigen Hypothesen in der Wissenschaft zuzulassen, die sich falsifizieren lassen. Würde man annehmen, dass die Chinesische Medizin durch den Erfolg der Schulmedizin falsifiziert wird, dann hätte man ihr zwar das Charakteristikum der Wissenschaftlichkeit zugesprochen aber leider eben auch – als falsifizierte Wissenschaft – den Status einer aufzugebenden Theorie. Dieser Falsifizierungsversuch geht aber fehl, denn die Ergebnisse naturwissenschaftlicher Forschung sind, ohne eine Anbindung an die chinesische Terminologie (und diese Anbindungsmöglichkeit muss erst noch ge35
T. S. Kuhn. Die Struktur wissenschaftlicher Revolution. (Frankfurt a. M.: Suhrkamp, 1976) S. 38. 36 A.a.O, S. 51. 37 Der Terminus Schulmedizin wurde Ende des 19. Jhdts., in Abgrenzung zu anderen Heilansätzen, in der homöopathischen Tradition geprägt.
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Susanne Hiekel
zeigt werden) als Falsifikatoren der chinesischen Medizin nicht zulässig. Die Popperschen Basisätze, mit Hilfe derer Theorien falsifiziert werden können, sind Sätze die über Beobachtung intersubjektiv nachprüfbar sein müssen. Diese Intersubjektivität verdankt sich aber einem gemeinsamen Rekurs auf die gleichen Hintergrundannahmen – die Basissätze sind als solche also konventionell bestimmt. In diesem speziellen Fall handelt es sich aber um zwei Sets von Hintergrundannahmen, die zunächst nicht kompatibel erscheinen und Intersubjektivität scheint nur lokal herzustellen zu sein. Während die Schulmedizin unter dem atomistisch-mechanistische geprägten Forschungsparadigma arbeitet, arbeitet die chinesische Medizin unter einem prozessual geprägten Forschungsparadigma, das die Annahmen des schulmedizinischen Paradigmas, dass der Rückgang auf beobachtbare Substrate als Wirkursachen notwendig ist, nicht teilt.38 Beide Paradigmata stellen ihre Kernannahmen nicht zur Disposition. Der Begriff des Forschungsparadigmas ist in der historischen Analyse Kuhns allerdings mehr wissenschaftssoziologisch oder –psychologisch konnotiert. Ein Wechsel von einem Paradigma zu einem anderen kommt eher einer religiösen Konversion gleich. Man kann nach Kuhnscher Sichtweise die wissenschaftssoziologische These vertreten, dass die beiden Ansätze Schulmedizin und Chinesische Medizin zwei Paradigmata einer normalwissenschaftlichen Forschung darstellen und es dann der historischen Entwicklung überlassen, welches Paradigma sich durchsetzen wird. Dieses Vorgehen scheint aber nicht sehr befriedigend. Ausgehend von Kuhn und den Überlegungen Poppers entwickelt Lakatos daher den Ansatz der wissenschaftlichen Forschungsprogramme, der ohne die wissenschaftspsychologischen und -soziologischen Konnotationen Kuhns auskommt und der Erkenntnis Rechnung trägt, dass Forschungsprogramme die Kernüberzeugungen verteidigen. Mit Lakatos wird eine rationale Rekonstruktion des Wechsels von einem Forschungsprogramm zu einem anderen ermöglicht und unter der Position des raffinierten Falsifikationismus kann nun überlegt werden ob eine der beiden medizinischen Perspektiven gerechtfertigter Weise vorzuziehen ist oder ob sie als parallele Ansätze anzusehen sind, die nebeneinander Bestand haben.
38
Eine weitere philosophische Beschäftigung um den generellen Konnex von atomistisch mechanistischen und prozessual geprägten metaphysischen Perspektiven und spezifisch von schulmedizinischer und chinesischer Medizin scheint daher dringend angeraten.
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
Dass eine der beiden Perspektiven eine größere Anhängerschaft hat als die andere (und es ist hier egal, welche der beiden medizinischen Ansätze punkten würde) kann kein rationales Kriterium sein, einer der Perspektiven den Vorzug zu geben. Nach Lakatos ist eine Theorie akzeptierbar, wenn sie einen bewährten empirischen Gehaltsüberschuss gegenüber rivalisierenden Theorien hat, d. h., dass sie zur Entdeckung neuer Fakten führt und dass etwas von diesem Gehaltsüberschuss verifiziert werden kann.39 Eine Theorie wird also nicht über einzelne Sätze zurückgewiesen (wie bei Popper), sondern über eine Folgetheorie, die den Erfolg der in Frage stehenden (Vorgänger-)Theorie erklären kann und die darüber hinaus einen explanatorischen Vorteil bietet. Die beiden medizinischen Ansätze sind in dem Sinne keine Theorieangebote, die in einer Folgetradition stehen, denn sie sind weitgehend unabhängig voneinander entwickelt worden. Weder kann die Schulmedizin die Erfolge der Chinesischen Medizin erklären noch umgekehrt. Die beiden Terminologien stehen sich bislang unübersetzt gegenüber. Dementsprechend kann nur innerhalb der Schulmedizin oder eben innerhalb der Chinesischen Medizin entschieden werden, ob eine Nachfolgetheorie besser ist als die vorhergehende, nicht aber kann diese Entscheidung zwischen diesen beiden Forschungsprogrammen getroffen werden. Hinsichtlich des explanatorischen Vorteils kann die Schulmedizin ins Feld führen, dass sie sich in den Kontext der Naturwissenschaften eingebunden sieht und mit diesen zusammen forscht. Der analytisch-mechanistisch substrathafte Ansatz ist in Physik und Chemie etabliert und das Renommee dieser Wissenschaftszweige steht der Schulmedizin gut zu Gesicht. Die Biologie ist hier allerdings Spielverderber. Sie entzieht sich dem Allgemeingültigkeitsanspruch der analytisch-mechanistischen Tradition, die die Ursachen für etwas stets auf die Elemente der Mikroebene zurückzuführen sucht und weist eine generelle Reduzierbarkeit zurück. Es gibt natürlich auch Disziplinen der Biologie die unter dieser Methodologie arbeiten wie z. B. die Molekularbiologie und die Genetik, aber im Bereich der Biologie sind viele Überlegungen gerade nicht dadurch ausgezeichnet, dass alles auf das Zusammenwirken kleinster Bestandteile zurückgeführt werden muss wie z. B. in der Ökologie und der Evolutionsbiologie. Sogar prozessbasierte Überlegungen erscheinen im Kontext der Evolutionsbiologie sinnvoll zu sein. Das heißt natürlich nicht, dass hier ein Konnex zum in China 39
Vgl. Imre Lakatos. The Methodology of Scientific Research Programmes. Philosophical Papers Vol. I (Cambridge: Cambridge University Press, 1978) S. 31f.
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entwickelte Gedankengebäude besteht, sondern nur, dass der analytisch-mechanistische Ansatz nicht überall – und auch nicht in allen Naturwissenschaften adäquat erscheint. Es muss allerdings zugegeben werden, dass prozessorientierte Überlegungen philosophisch wie biologisch sich quasi in den Kindeschuhen befinden und der Ausarbeitung bedürfen. Nichtsdestoweniger kann der explanatorische Vorteil der Schulmedizin, den sie über die Anbindung an die Naturwissenschaften zu erhalten versucht, in dieser Hinsicht relativiert werden. Ein explanatorischer Vorteil kann auch darüber gegeben sein, dass eine der medizinischen Ansätze besser Krankheiten / Disharmonien erklärt bzw. mit der entsprechenden Erklärung positiv in die Zukunft prognostiziert, indem durch die adäquate Therapie ein Heilerfolg erzielt wird. Hier liegt wie schon mehrfach erwähnt die Schulmedizin in der Notfallmedizin, in der Therapie von Infektionskrankheiten und in der chirurgischen Tradition u. ä. weit vorne. Man kann hier im Sinne Lakatos‘ von einem progressiven Problemshift sprechen, weil aus Sicht der Chinesischen Medizin, durch den Behandlungserfolg der Schulmedizin neue Fakten vorgelegt werden, die mit dem Instrumentarium der Chinesischen Medizin nicht ohne weiteres erklärt werden kann. Die Chinesische Medizin kann aber in anderen Bereichen ebenfalls mit Erfolgen aufwarten so z. B. bei der Behandlung von chronischen Leiden wie z. B. Rückenschmerzen, Allergien etc. und ihr Behandlungserfolg mit ihren Mitteln kann von der Schulmedizin zunächst auch nicht erklärt werden. Hier scheint eine Pattsituation vorzuliegen. Schulmedizin und Chinesische Medizin haben anscheinend unterschiedliche Erfolgsquoten in unterschiedlichen Typen von Krankheiten / Disharmonien vorzuweisen. Um hierzu aber genaue Aussagen machen zu können ist eine ernsthafte Auseinandersetzung mit der Erfolgsquote der Schulmedizin und der Chinesischen Medizin erforderlich, damit ein Vergleich vorgenommen werden kann. Es kann also – so die hier noch empirisch unfundierte Vermutung – nicht von einem prinzipiell vorliegenden, sondern eher von einem regionalen explanatorischen Vorteil gesprochen werden. Ein von Popper in die Bewertung von wissenschaftlichen Hypothesen in Anschlag gebrachtes Kriterium ist das Kriterium der Einfachheit. Man könnte das Forschungsprogramm der Schulmedizin besser bewerten, weil es das Prinzip der Einfachheit in dem Sinne besser erfüllt, weil weniger Entitäten eingeführt werden, um ihren Erfolg zu rechtfertigen – sie braucht eben kein Qi, dass sich nicht messen lässt. Dem kann entgegen gehalten werden, dass die Schulmedizin eine Vielzahl von Entitäten mehr in Anspruch nimmt, indem sie die Krankheiten 86
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Traditionelle Chinesische Medizin – ein paralleles Forschungsprogramm
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von der phänomenalen Ebene auf die Mikroebene zurückführt und diese Mikroebene viel reichhaltiger ausgestattet ist als die phänomenale Ebene. Die ästhetischen Kriterien der Theorienauswahl – Einfachheit und Eleganz – sind allerdings mit Vorsicht zu genießen. Es sollte hier eher Occam mit dem Leitsatz ‚entia non sunt multiplicanda praeter necessitatem‘ stark gemacht werden. Ein bloßes ‚mehr‘ sollte mit Occam nicht ohne weiteres rasiert werden: wenn eine Entität notwendig ist, dann sollte sie Bestand haben; ist sie nicht notwendig so sollte sie keine Verwendung finden. Die Notwendigkeit eine Entität einzuführen ist in der Medizin an den Therapieerfolg bzw. an den Therapieerfolg mit möglichst wenigen Nebenwirkungen gebundenen. Solange ein medizinischer Ansatz dies gewährleisten kann, wird er am harten Kern seines Forschungsprogramms mit seiner investierten Ontologie nicht rütteln lassen. Prinzipiell kann daher das in der Praxis liegende Fundament beider medizinischen Ansätze folgendermaßen formuliert werden: ‚Wer heilt, hat erst einmal gute Argumente auf seiner Seite‘. Die weitere Beurteilung ist dann auf einer Metaebene durchzuführen, indem genau analysiert wird, wo die Heilerfolge liegen und wer besser oder schlechter abschneidet. Wer Recht hat, wird dann tatsächlich durch den evidenzbasierten Erfolg entschieden.
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Chapter 2
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European Reflections on Problems of Health and Medicine
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Culture and Medicine in the Philosophical Materialism and Constructive Realism
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Nicole Holzenthal (University of Oviedo, Intersophia – International Network of Philosophical Studies)
My contribution to the congress The Concepts of Health and Disease – from the Viewpoint of four Cultures which took place in May 2013 meant a further step in my comparison of two philosophical approaches, as they are the Constructive Realism by Friedrich Wallner on the one hand (*1945, Austria), and the Philosophical Materialism by Gustavo Bueno on the other hand (*1924, Spain). Due to the fact that both approaches have in common that they consider themselves as constructive philosophies, they work on Theory of Science, and both work intensively on “Medicine” and “Culture”, I will try to draw the similarities and the differences when they speak about the relationship between Culture and Medicine. My Congress lecture was structured into four main points I am going to maintain in the current article: 1. What means Culture in both approaches? 2. What is Medicine or what are healing systems? 3. “Interwovenness” in certain “Ethnomedical approaches” 4. Against dualisms
1
What means Culture in both approaches?
In both philosophical systems culture is seen as a framework of human activity. It is the totality of possibilities in which the operations of a determined group of people move, and at the same time these are, above all, the result of the opera-
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tions realized by former habitants. So in this sense, culture is always constructed, it is an “artifact” or better, it means a complex whole of constructed artifacts, possibilities of behavior and a certain world order. The Constructive Realism names it “life world” and the Philosophical Materialism calls it a “morphodynamic system”. What is there to say, more concretely, about this “life world” in Constructive Realism? As a kind of framework, a life world is a system of proven convictions or believes handed down to us, i.e. the background that is specific of each culture. Although the “life world” itself is a construction, it must be emphasized that it is not scientifically, but cultural-social-historically constructed. So to say, it is all these things we are taken for granted without questioning them and sometimes even without having consciousness of this fact and its influence it our way of doing things and of making science. According to the Constructive Realism, Westeners live in a clearly different life world from Asiatic people, and African people have once again a different “life world”. Now you may ask: What does the life world serve for? The main function of the life world is to offer security to the people in their everyday-life. The argumentation of Constructive Realism is the following: Each life world determines human operations. But not only in their everyday-life, what is even more interesting to us is that it also determines human operations of scientists when they do science. In other words, culture has its influence in their scientific actions. The consequence is that in each sociocultural or historical context, the life world determines the group’s scientific system in a different way than other life worlds do. This fact leads to different sciences. That is why, following Wallner’s argument, Chinese sciences were and are so different from Western sciences. Due to their different life world, Chinese Medicine is so different from Western Medicine. All this is due to the fact that all these sociocultural conditions offer or determine the presuppositions of the way a science is constructed, and Medicine and healing systems must be determined by each life world’s own suppositions. We have to emphasize: life world in Constructive Realism is another constructed world than the one that is constructed by scientists in the moments they do science. Because scientists construct the so-called “reality”, which is the sum of all the scientifically constructed microworlds. Now the logical question we have to ask is: What relationship is there between Reality and Life world? The Constructive Realism states clearly that this is an important relationship, and stresses that it is mutual. While the scientific reality “intervenes” the cultural-historical life world, on the other hand the life world “interprets” the 92
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Culture and Medicine in the Philosophical Materialism and Constructive Realism
scientifically constructed reality. This is a very interesting approach because Theory of Science has not always recognized this close relationship between culture and science. Nor was it always obvious that science needs to be interpreted in everyday language and thought by non specialists in this matter, as Wallner states. The Philosophical Materialim (Philosophical Materialism), on the other hand, does not speak of “life world”, altough the term “culture” is also criticized very much by Gustavo Bueno, especially in his book I translated into German in 2002, Der Mythos der Kultur. Essay einer materialistischen Kulturphilosophie [The Myth of Culture. An Essay of Materialistic Philosophy of Science]. Bueno argues there that it is a myth because culture means so many things at the same time that the term is obscure and confusing – culture may be understood as a lot of scientific conceptions, but culture as well can be many philosophical Ideas, many of them incompatible with each other. So Bueno introduces the syntagm “morphodynamic system” in order to make understandable what can be saved after all the work of “triturating” the myth. With “morphodynamic system” he tries to create a positive conception of what culture means: a system that has its structure but still it is dynamic. I compared this conception with Wallner’s life world in my last article called “Die Kultur – ein Konstrukt” (Culture as a Construction) in the book Construction and Interpretation –Concepts of a Culturally Guided Philosophy of Science published in 2013. Now you may ask: If for in both approaches, culture is built up by human constructions, why does Constructive Realism need to emphasize that science depends very much on culture, whereas the Philosophical Materialism apparently does not insist so much in that point? The culture called “life world” in terms of the CR is considered by Wallner as a separate ontological sphere. That is why I consider that there is a necessity to emphasize the influence of this sphere into the constructed world of scientific or medical reality. On the other hand, in PhM culture, considered as a “morphodynamic system” is no separate ontological sphere, but a general basis and result of human accion. In the Philosophical Materialism culture does not only interprete the science in question–to be more precise, this is more a task of Philosophy than of culture. Culture offers something quite different: it provides the “material”, i.e. the social, cultural, political etc. matters, and only with these materials the construction of the sciences can takes place. And furthermore, culture somehow “embraces” sciences. For the Philosophical Materialism the different scientific fields are parts
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Nicole Holzenthal
of the morphodynamic system which means “culture”. In other words, the “morphodynamic system” consists of “institutions”, and sciences themselves are cultural institutions. Trying to explain this in the words of Constructive Realism, i.e. making a strangification of this idea of Bueno into Constructive Realism, we could say: The Philosophical Materialism conceives science as part of life world itself. That is, life world for Bueno is supposed to be embracing the “reality”. Thus, there is a question a Philosophical Materialist could direct to a Constructive Realist, which is: Does life world also include Reality as one of its forms? As I understand the texts of Wallner, it does not. Because in Constructive Realism, Life world and Reality are two distinct ontological areas. And that is just why Wallner needs to insist in the influence of culture into cientific construction. Otherwise it would not be obvious that each particular culture determines all the scientific actions that are undertaken in its framework, as the Constructive Realism defends. So we read very often sentences like: Chinese culture influences strongly in Traditional Chinese Medicine. In this context, a distinction made by the Philosophical Materialism is quite useful between two moments of science: the “genesis” and the “structure” of science. Why? Because it is helpful to analyse if or when culture influences in science. When Bueno speaks about the genesis of a scientific discipline – that is when a new scientific field is about to be constructed – this process of scientific genesis is culturally determined. I consider that Bueno and Wallner agree with each other on this point. But Bueno states more precisely that the main influence of culture into science takes place in this “genesis” moment. Each morphodynamic system (with its sociocultural, historical, economic, artistic conditions) determines the cultural group´s scientific system just in the moment its scientists construct their science. And so once it is clear which field a science occupies, the terms it includes, the operations it allows, and so on, then the genesis process is operationally more or less concluded (although science continues being dynamic and flexible). And once this “closure” has happened, the Philosophical Materialism starts to concentrate on the “structure” of this science. You may now ask: Why is that supposed to be important for us? The importance of the differentiation between genesis and structure becomes very important, if we recognize that there are disciplines in which cultural traces keep very present at any moment, i.e. not only in its genesis, but also in their structure. Bueno discovers sciences which have a more culturally influenced structure than others do. The PhM considers that there are other sciences with a culturally more “neutralized” structure, as chemistry, por example. The CR, on the other 94
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Culture and Medicine in the Philosophical Materialism and Constructive Realism
hand, emphasizes cultural traces even in the supposedly “neutralized” natural sciences such as in current Physics. But when Wallner assignes the “culture” the task of interpreting science, in terms of PhM – i.e. now translated or “strangified” into the PhM terminology–this could be understood as following: CR says that cultural sciences must interprete what is science and what propositions the sciences work with. If we now understand that Wallner supposes that Philosophy is one of these cultural sciences, we reach the point where we see that also Wallner admits that Philosophy may assume the task of interpreting sciences, which in terms of PhM means: Philosophy is a “second degree” discipline, one could also call it meta-discipline. What does this mean in our case of healing systems? We now understand that, due to the fact that Wallner regards “life world” as a separate ontological sphere (one of three), this separation makes it necessary for him to emphasize that there is an important influence of this life world sphere into the constructed world of scientific reality, and so into Medicine. I assume that Wallner is absolutely right to insist in the importance of life world for a healing system. But I also consider that it is due to the separation of the two constructed worlds, and probably this dependence of medical reality on life world was not as obvious at first sight as was for the Philosophical Materialism. I mean, Bueno would never deny the influence of culture on the healing system because when in Philosophical Materialism culture is regarded as a “morphodynamic system”, it is never a separate ontological sphere from a concrete knowledge field. At best, it is “dissociated” by the philosopher of science in order to understand the constellation. Instead, Bueno considers that culture (the morphodynamic system) is at the same time the general basis and the result of human accion and thus scientific operations, and it always works in each cultural group. So in the construction process of an emerging science (i.e. in its genesis process), the Philosophical Materialism takes it for granted that any construction is based on the conditions which each particular morphodynamic system offers. A science or discipline as especially Medicine or the area of operations of a healing system is a part of a culture, it is an institution of a concrete culture. That is why cultural propositions are involved in the construction of Medicine, i.e. in the construction of any healing system. In addition, the medical discipline is one of those which always keeps cultural aspects in its structure. By the way, I recognize that one (from the standpoint of CR, for instance) may criticize that, as a science is always supposed to be dynamic, this distinction between genesis and structure might sound a little artificial, but it helps to clarify.
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But if one speaks of the “moments” of genesis and structure in terms of the PhM, they are not moments in the chronological sense, but in the gnoseological one.
2
What is Medicine or what are healing systems?
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2.1 Medicine is a system of operations What both constructivist approaches have in common is that a healing system is regarded as a “system of operations”. But out of this common standpoint, Bueno draws diffent conclusions from the ones Wallner does. Very briefly, Medicine is defined by Wallner epistemologically as a “system of knowledge” or a “preposition system”. As any science is (for the Constructive Realism). But Bueno doubts the scientific status of healing systems as such. Most of them might be regarded just as operational systems without being themselves scientific. We will get back to these points. As we have seen, Wallner stresses on the point that there are many culturally different healing systems, i.e. scientific operational systems for healing. Wallner’s criterion for a healing system to be “scientific” is simply that it must work, i.e. the constructions should reach good healing results, furthermore it should be based on a consistent argumentation, and, very important, it must fulfil the structural needs of the culture where it is rooted. Bueno considers Medicine itself an art or a praxis, as such it is clearly a “system of operations”. But not any operational system must be scientific. So to say, many healing proceedings are not scientifically fundamented. The “intercultural” question of how different healing systems work is raised by Bueno when speaking about Cultural Anthropology. In this framework, healing processes play a very central role because every people have their (own) healing procedures. As healing procedures are considered “cultural ceremonies” by Bueno (and as such, they are “institutions” in the broader sense), it is obvious for the Philosophical Materialist that they are culturally determined. Both approaches share this point, as we have seen. But one clear difference to the constructive-realistic approach is that from the materialistic perspective of Philosophy of Science, Medicine as a discipline means that in its field you find the human being considered as an individual body (and its parts). In other words, in Medicine you do not regard the human e.g. as a member of a social or political group or even part of a bigger totality. Wallner 96
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Culture and Medicine in the Philosophical Materialism and Constructive Realism
sees himself in the need of admitting Medical systems beyond this (occidental) limitation because the TCM is much more holistic. But for Bueno the tallest term of Medicine the individual human body, which is complex, and might show either of two conditions, which are, at the limit: healthy or ill. Wallner considers this body reference as typical for occidental way of thinking, which Bueno would not deny. Although, when the Philosophical Materialism uses the conceptions of “health” and “disease”, they are not considered substances but relationships. And these relationships determinate not only the entire bodily human individual, but also its “regions”, i.e. the healthy or ill organs or members.66 The field of Medicine is made up by terms like organs, tissue, members etc., which belong to individual systems, and are classified according to age and gender. With no doubt, ultimately, this fits to what is generally called “Biomedicine”, i.e. the European Medicine. It does not fit well to holistic approaches like the Chinese one. Furthermore, when Bueno speaks about “Medical Anthropology”, it is not the same as what it meant in English. Here “Medical Anthropology” includes explicitely the cultural study of Ethnomedicine. For Bueno, instead, “Medical Anthropology” seems to be just what others call simply “Medicine”, as far as the theoretical discipline is concerned, dealing with anatomy, physionomy, but also with health and disease. Meanwhile, when the PhM speaks merely about “Medicine”, it means especially the practical discipline of healing processes. Probably that is why he does not affirm its scientific status. Wallner calls this practical part, as I understand him, simply healing system. 2.2 Medicine is normative Wallner speaks about Medicine trying to achieve the “state of should be”, instead of hypostasing the actual state of “what is”67. In this sense, Medicine is normative. The Philosophical Materialism also regards the normative aspect as an essential point of Medicine. Although, enfasizing that there is a norm, a “should 66 This Idea of Gustavo Bueno was already expressed in the “Epílogo” (1987) in Etnología y utopía. 67 See Friedrich Wallner: Systemanalyse als Wissenschaftstheorie II: Kulturalismus als Perspektive der Philosophie im 21. Jahrhundert. Bern/Frankfurt/New York/Brüssel: Peter Lang, 2010, 255.
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be”, Bueno goes even a step further, saying that there is an “ideology” implied in Medicine. It can generally be summarized as the following: A physician should always try to achieve health, never disease. The operations (including the organ trasplantations) are transformations oriented towards transforming the individual body or its parts from the ill condition into the healthy one. The contrary transformation is strictly prohibited by the ideological norm which differentiates the body of physicians from other groups of professionals.68 This leads us inmediately to questions of Ethics. Medicine, as far as it is an art or a practice, is not considered by Bueno an “applied Ethics”, but “fundamental” and “original Ethics”. Why is it so? The PhM argues that a large tradition understands Ethics itself as the practical attitude of keeping human bodies healthy, i.e. the transforming ill bodies into healthy ones. Thus, Medicine prohibits any practice of transforming healthy bodies into ill ones. On the other hand, these transformations of healthy bodies into ill bodies are of interest for another scientific discipline, namely Biology. Whereas in Biology you might carry out experiments which worsen the animals´ state of health, it is absolutely prohibited for a veterinarian or physician to do that. That is why Biology enters into permanent conflict with Medicine. For example, a biologist may be interested in a cancer or other bad symptoms – a biologist as such has no biological impediments to introduce a disease into a healthy animal –, instead, as I just said, a physician or veterinarian must never worsen the state of a human being or animal. Such a behavior is normatively contrary to the fundamental convictions of Medicine, i.e. to the Ethics which form the proper basis of this discipline. In our tradition these deontological norms are formulated as oaths. Thus, to convert a healthy body into an ill one is against the Hippocratic Oath, the Oath of Maimonides, or Physician's Oath by The World Medical Association Declaration of Geneva, and so on. These promises of good behavior are usually declared in a certain historical context, but once formulated, they have the intention to last forever. Thus, the lattest was formulated after the atrocities of human experiments not only by biologists, but also by physicians during the nacionalsocialist regime, especially in the concentration camps, and this oath was declared in 1948.
68
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See Gustavo Bueno: Etnología y utopía. “Epílogo” (1987), 198-199.
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Culture and Medicine in the Philosophical Materialism and Constructive Realism
2.3 Big differences concerning the question of the “targets” of healing systems At this point, it is interesting to ask what the discipline of Medicine is considered about. What targets and values (or ideological value system) do e.g. Western physicians imply (explicitly or implicitly) or what do healers belonging to other cultures imply? That is what the Constructive Realism would call “presuppositions”, and they are of mayor interest for both, Wallner and Bueno. The Spanish philosopher states that Medicine (i.e. Occidental Biomedicine) aims at the preservation of the human “canon” in as many situations as possible. In discussions on bioethical questions, Gustavo Bueno started to distinguish sharply the targets of the two mentioned disciplines, namely Medicine and Biology. Biologists look at species and are often very interested in mutations and variations, whereas physicians try to maintain or recover not only the state of health, they even try to recover the established canon of human being in each body. In this sense, Medicine is immersed into a very strong ideological conviction. Physicians believe it is their duty to maintain or reestablish what is considered the typical human body.
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Example 1. Conjoined twins as a typical (i.e. ethical) question for Medicine Bueno gives an example for an ethical question which is very characteristic of Medicine and which, above all, shows well the ideological implications. The so-called “Siamese twins”69 which should be better called conjoined twins. We have a look at two well-known cases, Abby and Brittany Hensel who continue living as conjoined twins, and Kendra and Maliyah Herrin who were surgically separated.
69
The first conjoined twins who caught international attention were Eng and Chang Bunker. They were born in 1811 in Siam (now Thailand), that explains the denomination. They were joined at the chest and although the knowledge was not available at the time, it would now have been possible to separate theses twins, using today's medical techniques. After suffering severe bronchitis, Chang died in January 1874 and Eng shortly afterwards.
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1. Abby and Brittany Hensel (from their public facebook profile)
2. Kendra and Maliyah Herrin (from their public facebook profile)
According to the Philosophical Materialism, the ideology implicitely going with Western Medicine directs physicians to impede human forms with strange deformations (e.g. two heads on one body) or to redirect them to the canon. Although statistically these conjoined twins cases are insignificant–there are possibly fewer than 12 adult pairs of conjoined twins across the world today–, their
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Culture and Medicine in the Philosophical Materialism and Constructive Realism
mere existence brings up questions which are philosophically extremely important. Let us just to mention some important data of the two cases. (1) Currently, Abby and Brittany Hensel “live in one body” with two sets of lungs, two hearts, two stomachs, one liver, one large intestine, one reproductive system and two legs. Abby and Brittany Hensel have learned to co-ordinate their body, with Abby controlling the right hand side and Brittany the left. They have got two passports, but they travel with one ticket. They drive the car with two hands (each brain directs one hand), two feet, two legs and two brains. (2)A recent case, where conjoined twins were sucessfully separated are Kendra and Maliyah Herrin. They were approximately four and a half years old when they were separated. Kendra retained the single kidney which the twins had shared. Maliyah immediately began hemodialysis, which continued for eight months, when she was transplanted with a kidney donated by her mother. Following their separation surgeries, both girls, each one with only one leg, began learning to walk using crutches. Currently, they are supposed to be fitted with prosthetic legs. What these cases show is that whenever possible (and the affected persons accept), Western physicians try to perform surgeries separating the conjoined twins. In the past, in many occasions one of them or even both have died during or after these operations, because the surgical separation of conjoined twins is a risky procedure. Mortality rates vary, depending on their type of connection, and the organs they share. Thus, in order to determine the feasibility of separation, obviously physicians must carefully assess how the twins' share organs function. For example, twins joined at the sacrum at the base of the spine have a relatively high percent chance of successful separation, whereas in cases of twins with conjoined hearts at the pumping chamber level, there are no known survivors. So in each case it is a difficult (medical-ethical) decision if surgical separation is to be attempted. In cases of conjoined twins, the decision which has to be taken is between the presupposition that every human body should meet the known canon of a healthy (canonical) body, on the one hand, and the ethical denial to sacrifice neither of the individuals treated, on the other hand. What Western Medicine’s ideology strongly suggests is separation, whenever feasible. As far as I know, conjoined twins separation is no issue medically discussed in any other healing system.
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Definitions of Health, Disease, Illness, and Sickness We will now have a look at the terminology and the conceptions of “health” and “disease”. Philosophical Materialism defines both extremes, for Western Biomedicine, as the following: health is when the body is meeting the canon of normal human being; whereas disease is when a body (or parts of its systemic functions) strayed from the canon established for human beings. That is why Western Biomedicine tends to eliminate deviations. There is a large agreement of Philosophical Materialism and Constructive Realism establishing that Western Medicine is body-oriented. We will just come back to that. There is an interesting differentiation between disease, illness and sickness generally used in English by Medical Anthropologists–here Medical Anthropology is used in the sense of Ethnology studying medical treatments in the different cultures–. This tree part differentiation used by Horacio Fabrega70 is the following one:
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Disease is when the body differs from the healthy conditions (biomedical dimension), sickness are their social and psychological dimensions, and illness are the cultural dimensions of such a state.
We can see, if we speak of “disease”, we stay in the Western Biomedical tradition, at least implicitely. Taking for granted that the individual body should be the reference of Medicine, though, we omit not only the problem of the conjoined twins, but we neither ask a further question, which must be confronted, and this is a intercultural one: Is the “preservation of the individual body” not an approach which is typical of European culture? That is, do not other healing systems often set more collective or more holistic targets? As a consequence of this, if the focus of a healing system is, for example, on a human community, can we still speak about the same discipline, gnoseologically speaking? Bueno would say no, Wallner would say yes. In this sense, the Philosophical Materialism has a stricter conception of Medicine than the Constructive Realism which offers a broader Medicine conception. The PhM works with the preservation of the canon in each individual human body, and the CR accepts even spiritual or communal healing systems as science.
70
Horacio Fabrega Jr., MD, is Professor of Psychiatry and Anthropology at the University of Pittsburgh, Pennsylvania, USA.
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From the perspective of the materialistic ontology by Gustavo Bueno, “disease” thus is the first kind of materialiy, whereas “sickness” refers to the second one, and “illness” roughly matchs with the third and most abstract one. I think we have to observe, that a good occidental general physician in practice not only looks at the disease, but also considers the second and third aspects. From Wallner’s viewpoint, this is just a question of beeing a lucky patient, and for Bueno, social, psychological, and cultural aspects seem not to have a great importance neither. I think, at this point both exxagerate. Nor does actual Western medical practice or healing procedures exclude these aspects, nor should they be of no importance for the Western medical theory. In the current literature on “Ethnomedicine” usually there appear two types of non-European healing systems, according to their conceptions of illness. The first type englobes so-called “personalistic systems”: here active agents, related to persons and moral actions, are considered to cause illness. Thus, religious and magic activities appear profoundly interwoven with the healing procedures. You may find this type of personalistic healing systems, for example, studying the New Guinean Maring. On the other hand, there are the so-called “naturalistic systems”, where illness is usually considered as a lack of balance. Responsibility there is said to be centralized in the patient and the causes are not as vague as in the “personalistic” systems. The usual example for the “naturalistic” kinds of healing systems is TCM. As we will see later, Wallner strongly contradicts this classification. Example 2. Tsembaga Maring people of New Guinea Let me give you an extreme example for a healing system. Some New Guinean people did not conceive the individual body until they were confronted with European culture in the 1950s. There is an anecdote I read about a Guinean person who once confessed to an ethnologist: “you gave us our body”. Until the moment they were colonized, everybody of this cultural group conceived himself only as part of the Maring community and as immersed into a spiritual whole. They all considered themselves as determined by nature inhabited by spirits coming from the ancestors. Bueno would say that it is not possible that these people had a Medicine, although obviously he would recongnize that they had developed healing procedures. Would the Constructive Realism say that these healing procedures were “Medicine”? In a moment, I will give you some examples of their procedings.
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As many ethnologists do not want to compare the studied peoples´ healing system with the Western Medicine, usually at this moment of the discourse is where they introduce the term “Ethnomedicine”. This term tries to put the non-western healing systems at the same academic level, but at the same time, it puts Western Medicine apart. The ones who try to comprehend healing knowledge and practices of different cultures and their conceptions of health and illness, which are constructed due to their cultural framework, at some universities will find institutes which deal with similar issue, and they are very often called Ethnomedical Departments or the like.71 Now we could try to reformulate our last question in the following way: May we accept that the target of Ethnomedicine 72 be not always individual body, but also the “natural” or “universal” “whole”, the community or even spiritual entities? Ethnomedicine usually includes the treatments of all these kinds. You see that already when non-occidental medical systems are classified73, according to two types of etiological conceptions of illness I just mentioned. Neither the “personalistic” Ethnomedicine – the spirits causing illness are considered persons –, nor the “naturalistic” one – where nature is in disorder because of a lack of balance – neither of them are based on the individual human body. The so-called “personalistic systems” of illness conceptions are considered to be characteristic of indigenous societies: the causes of illness are usually interpreted in terms of active agents related to living or dead persons and moral actions. Envy, for example, may be translated as evil eye and cause illness. In this type of medical systems the responsibility for illness is not ubicated exclusively in the patient, but attributed to more “peripheric” instances. Religion and magic appear profoundly interwoven with the conceptions of illness and healing.
71
“Ethnomedicine highlights the cultural framework in terms of which societies understand and shape the subjective experiences of sickness and healing” writes Horacio Fabrega, Jr: “The need for an ethnomedical science”. Science 189 (1975): 969. 72 “Virtually all non-western Great Medical Traditions involve metaphysical as well as naturalistic dimensions […]. All ethnomedicines rest on culturally sensitive formulations of sickness and healing exemplified as humanistic, moral considerations involving persons and their life circumstances.” (Fabrega, Horacio: “Ethnomedical and cultural foundations of psychiatry for the person” in The Internationa Journal of Person Centered Medicine. The University of Buckingham Vol 1, No 1 April, 2011) 73 George M. Foster, Barbara Gallatin Anderson: Medical Anthropology. New York: John Wiley K Sons, 1978. 51-80, as cited by Josep María Comelles: Enfermedad cultura y sociedad 1993, cap. 5.
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On the contrary, in the so-called “naturalistic systems” illness is attributed to a lack of balance without associating it with misfortunes or magic or religious processes. Here responsibility is usually centralized in the patient. Traditional Chinese Medicine is frequently used as the typical example for this “naturalistic” approach, because it has no magical components (any more), and the patient is placed in the centre of interest by the physician. Wallner refuses to consider TCM as “naturalistic” although illness is due to a lack of fluence balance. Many other critics had already observed that this division (personalistic/naturalistic) forces the world´s non-Western medical systems into a priori and static ideal types, and that there may be many overlapping systems. This is right, although this construction “personalistic system” fits quite well for the healing systems of tribes in New Guinea (as the one I will speak about in a moment, and which might have served as a model for the distinction), and thus the scheme helps to get closer to the next example. Due to the fact that their knowledge is often transmitted only orally, one can expect that the so-called “personalistic” healers work with a less systematizised theory or even may interprete oral healing tradition more arbirarily than healers who put into practice written theoretic works. Furthermore, these healing techniques are usually not to be distinguished from other techniques and activities of the same people. But even though, these healing procedings might also function up to a certain point with the diseases they are usually confronted with. Even the “personalistic” healers get experience with the diseases in question. We have to realize that healing procedures usually function because people are not stupid! They discover things by trial and error, although their “justifications” of why they function, might not convince us at all. So if for the Constructive Realism Medicine is a healing system, which at the same time is a system of knowledge or propositions with a normative aspect of “should be”. For example, in TCM the main target is to preserve the fluence balance within the human and with the universe. And if, on the other hand, Philosophical Materialism defines Medicine as a system of techniques with the target to preserve the typical shape of the individual human body (a “should be”). Furthermore, Medicine and healing systems themselves are cultural institutions. To be more precise, Medicine for the PhM is a cultural institution and healing procedings are cultural ceremonies.74 Then, as a consequence, in both, Con74
We see that some healing procedures might be not differenciated from other operative fields.
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structive Realism and in Philosophical Materialism, healing systems are funcioning systems of operations (healing activities), whereas interculturally the explanations, and the “targets” of healing systems might be very different. Now, a proposal that fittet to both philosophical systems could be the following: We could use the term “Medicine” for all those healing systems which have a written theoretic works on their back and search the causes of disease in patient-centrated contexts. Thus, on the one hand we could accept a more limitied radius of this field, as it is the the case of the individual body canon-oriented Western Medicine (see PhM), or on the other hand, we could choose a broader approach which included the holistic TCM (as the CR does). As a consequence, it might be the best to use the term “healing processes” or even “healing systems” for all the existing techniques which treat diseases, sickness and illness including the ones without a written doctrine, whereas it is recommendable to restrict the term of Medicine to those who have wrote it down. Thus, the expression “healing processes” should replace the so-called term “Ethnomedicines”, as far as it includes the so-called naturalistic approaches, the so-called personalistic healing procedures, and sometimes even Western Medicine.
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Example 3. Traditional Chinese Medicine as a holistic approach The founder of Constructive Realism, as we have seen, defeats the idea that TCM is naturalistic. He considers it is not justified to reduce the traditional Medicine of China, for example, to plants and their curing effectiveness. Instead, it has a very complicating argumentation from the viewpoint of Philosophy of Science.75 In opposition to the Western Medicine which has a morphological structure, Chinese Medicine centers in relations and functions. For Western Medicine experimental studies are fundamental, whereas a very important characteristic of the Chinese thinking is the “linguistification”76. Furthermore, contrary to the West’s reductionism and analytic approach, Traditional Chinese Medicine is holistic, in the sense that human beings are similar to the universe, and that the universe is similar to human beings.77 75
See this argumentation in Friedrich Wallner: Acerca del Realismo Constructivo. Lecciones de Oviedo. Oviedo: Servicio de Publicaciones de la Universidad de Oviedo, 2013, 28. 76 See Wallner: Acerca del Realismo Constructivo: 110. 77 Ibid.
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If now holism is understood as the idea of that in nature everything is connected to everything else, the Philosophical Materialism is very contrary to this idea. Because thinking consists in connecting just the things that are connected, i. e. not everything, implying at the same time that these things are not connected to other third things. Thus, connecting A and B may imply a disconnection with C. The critical philosophical methodology is established by Plato in The Sophist78 as the so-called principle of symploké, which opposes to the holistic monism (everything connected to any other thing; here defended by the traditional Chinese thinking) on the one hand, as well as to a radical pluralism (where nothing is connected with anything else), on the other hand.79
3
“Interwovenness” in certain “Ethnomedical approaches”
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As we have mentioned, in some cultures, healing proceedings are interwoven with other proceedings as for example religious activities, agricultural work or even political accions. Here I want to illustrate the characteristic “interwovenness” or extreme interconnectivity of a concrete “Ethnomedical” approach.
78 79
See Plato: The Sophist (251e-253e). See Gustavo Bueno: Sciences as Categorical Closures, 143, footnote 74.
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3. A Maring warrior
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4. Book cover of Rappaport’s main study (2nd ed.)
The people I studied for my PhD thesis, the Maring in the highlands of New Guinea, had developped a healing system incapable of be dissociated from the rest of their cultural structures. A series of ethnologists were attracted by them because of their “primitive” or “neolithic” life structure until the 1950ies. The American functionalist Roy Rappaport presented a pioneer study called Pigs for the Ancestors where he constructed models in order to explain their culture in terms of ecology. And among the studied rituals, healing procedures were also included. Rappaport’s Maring-clan, the Tsembaga, serve us as a perfect example for an extreme “interwovenness” of culture and healing system. I will, first of all, describe the low inner differentiation of their cultural ceremonies. We will see, they themselves cannot speak of different areas of activities as medical, religious, artistic, agricultural etc. activities. Afterwards, I will then try to show how the cultural ceremonies might be seen through a strangification into Western categories.
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3.1 An example of interwoven cultural structures in the healing system of a primitive people The Maring did not conceive a difference between magic proceedings and (so to say) profane activities. Even gardening and pig breeding meant to be religious issues to them. And as the activities were not differentiated, knowledge was not either. Thus, healing acts, e.g. in cases of Malaria disease, were at the same time religious ceremonies. In concrete, when somebody suffered from malaria, their explanation of why the person in question had fallen ill was usually based on the actions of some kind of spirits. In the traditional Maring thinking, the “rawa tukump”, spirits of the lower areas, when they get angry are supposed to put pieces of bamboo into the livers of ill human beings. So the “causes” for illness given by the Maring healer generally were “moral” ones: there were spirits offended by the clan the ill person belongs to. From the Maring perspective, spirits may be offended because this clan did not fulfill their duties of sacrificing pigs to their ancestors. So the clan is punished with illness, although (seen from our perspective) the one who suffers from the disease might be just one person. This healing system can be classified as “personalistic” because people believed in spiritual active agents causing illness that is why magic is profoundly interwoven with the causes and treatment of illness. The Marings’ explanations sound very strange to us (“bamboo in the liver, put by an ancestor spririt” etc.). Still their system functioned up to a certain point. Concretely, they had rituals which fulfilled effectively the function of avoiding malaria infection. As they considered that the most dangerous spirits lived in the lower parts of the territory, they refused to live in this area. And it was just there where the mosquitos live which may carry the parasite. Descending to these low areas of their territory was strictly regulated by ceremonial regulations. For instance, when entering into contact with these spirits, the clan members had to submit to strict taboos. Men were not allowed to have relations with women (nor eat juicy food) during the time they are allowed to descend to the lower areas. Now can we consider this proceeding a first step in direction to “preventive Medicine”? I regard it as doubtful because these procedings are totally interwoven with magic, they are magic rituals.
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3.2 Interwovenness seen through a strangification into Western categories
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If we observe how Roy Rappaport studied the cultural ceremonies of the Tsembaga Maring, we see that a strangification into Western categories is already taking place there. Rappaport considered himself as a functionalist, researching up to which point the natives´ explanations serve them to cope effectively with their environment. But he also compares these explanations with how Westerners explained the same reality from their “scientific” perspective. And he does this referring to their relationship towards illness, en concrete, Malaria infections. So in their ritual cycle the Maring culturally regulated their relationship to what they considered the “rawa tukump”, the spirits living in their lower areas. These spirits were considered to be dangerous, but also feminine; rotten, but also fertile. Furthermore, for the Maring these spirits were the souls of people who died of sickness or because of their age – so to say, those who did not die heroically. If we analyse these traditional beliefs from Western climatological, ecological, biological, and medical perspectives, it is just in these lower parts of their territory where humidity and the right temperature allow mosquitos–and among them, the Anopheles–to develop happily. Thus it is very intelligent to regulate and control the penetration into the lower areas, even from a biomedical perspective.
5. Anopheles host and transmit the plasmodium
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6. Plasmodium is the parasitic protozoa infecting with malaria
Anopheles is the Ancient Greek term for ‘non-profit’ or ‘useless’, and that is how Western biology calls the mosquitos which live in the lower Tsembaga areas. The female anopheles might carry the unicellular parasite called “plasmodium falciparum”. The infection by these organisms is known as “malaria”. So the Tsembaga are very right to regulate when and how to walk down to the lower territories, because the danger of getting infected by malaria is there. There is something “wirklich”. What the Maring construct in order to explain it, is different from what Western scientists construct on basis of the same issues, but still they are right up to a certain point. The way the Maring are coping with the danger, and once infected, the treatment they apply for healing the infected person is quite different from what Westeners recommend. When a Tsembaga healer treats an ill person, he considers that it is not only the patient who is affected, it is the whole clan whose relationship to the spirits in question has gone wrong. The Maring breed pigs in order to pay their depts with neighbours who helped them during the last war, but these payments are basically understood by them as sacrifices to the spirits. So as the healer tries to explain why a clan member has fallen ill, he considers that probably they are in dept with the spirits, i.e. probably they did not sacrifice all the pigs they owed the ancestors. As a consequence, the ancestors might have got angry and punished the clan with somebody falling ill. The healer then tries to appease the spirits in order to heal the ill clan member. Ceremoniously he tries to get off the bamboo split the “rawa tukump” supposedly have inserted into the patient´s liver. By the way, this bamboo split could be interpreted as a very phenomenological way to describe
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the sharp pain the ill person might suffer. The healer gives the clan the instruction to sacrifice more pigs in order to pacify the “rawa tukump” and to help healing the ill clan member. He also reminds them of their duty to invite their allied Maring neighbors. The neighbours and the ill persons would be the only ones to have the right to eat the pork.80 We see clearly, the healer´s activities, to say it in our categories, merge magic or religious elements with political or juridical ones, nutritional with moral and ethical ones. For us, each aspect of the healer’s activity can be seen as belonging to another category: magic, political, nutritional, moral, etc. We are then using Western categories, and thus carrying out a “strangification”. From our occidental perspective, the Tsembaga Maring are mingling categories. Up to this point in their history they did not perceive these categories even as differentiated activity areas. Inserted into the Western context, the Marings’ mingling sounds strange, whereas, on the other hand, the Western and differentiated cultural areas must have been annoying to the Maring. Philosophical Materialism is concerned about the internal limits of the disciplines, and so it is of the Medical Anthropology as a science (on the one hand) and (Western) Medicine as a practical art on the other hand. Bueno seeks, at least, an “operative closure” for Medicine because such a closure allows a physician to know in every moment what activities are medical, which ones are not. This is very useful for our case. On the one hand, no Guinean relative, for instance, would have ever accused the healing “medicine man” of carrying out magical proceedings on his clan member, instead of medical proceedings. But on the other hand, if a Western physician starts to praise instead of treating the wounds, he looses his job. Due to the implicit occidental Medicial ideology he should leave the religious acts to other professionals, i.e. priests. Nor would anybody accept if a Western physician told a patient to invite generously his neigbours for dinner, and that if they did not, the patient would not regain his health. These political and magic areas are merged in some societies like the traditional New Guinean ones. But obviously you can only recognize this fact if you look at it from societies where these areas are dissociated. And in the end, these areas of activities built up “cultural categories”. In Western thinking, the 80
Rappaport´s explanation is the following: The meat is very fat and salted. These proteins and the seldom mineral, salt, serve the men to be strong and have fury for the next fights where the allied are once again involved because they accepted the tribe´s invitation.
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areas of operations or activities are very differentiated. And thus, healing is very clearly distinguished from magical or political activities.
4
Against dualisms
The Constructive Realism criticises the dualist tendency of Western thought architecture and, as a consequence, of Western Medicine, to work with constructed dualisms. This philosophical critique can be found also in the Philosophical Materialism, so it may lead to an important debate between the two philosphical approaches. I will comment here two dualisms very briefly: SUBJECT/OBJECT:
The first big dualism which is critisized by both philosophers is the subject/object dualism. Fritz Wallner says that disease is regarded by Western Medicine as an object, and criticises that. Gustavo Bueno proposes to regards disease and health as “relationships”, not as objects, and he does so in the framework of Western Biomedicine. Probably a non substantialist approach is a better way of handling diseases.
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SPIRIT/BODY:
As we have seen, Western Medicine focusses on the body. Approaches which do not are excluded from the operational field and might be considered as psychological disciplines, for example. Wallner goes so far as to polemicize that if there is no physical solution, Western physicians have to resort to psychologists and to the idea of a psyche that might have an influence on corporal problems. Bueno does not consider the “spirit” as a separate entity. In order to say it more simply: you may speak of somatic and espiritual, but only as “determinations”, not as entities. Gnoseologically (as a disciplinary field) Medicine focuses its attention on somatic determinations, more than on psychological ones, nobody doubts that. In both examples, what Philosophical Materialism has in common with the criticism of the Constructive Realism is that these specially European dualisms, which are often even considered dichotomies, are seen as separate entities. That is, our tradition tends to regard them as “exempt” committing the error of tak114
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ing each element of the pair as independent from the other one, and also as separated from the specific contexts they appear in. The parts of the dualism which now considered as exempt entities, become substances, and thus an undesired “hypostasis” has been taking place. For the Philosophical Materialism, both parts of the dualisms are connected to each other (as “conjugated pairs”), and they are inserted into a concrete context. Many questions, such as what kind of discipline is Medicine, is itself a science or not, stay unanswered for the moment. But as they need a broader space of development, they must be left for another occasion.
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Bibliography A. Construcive Realism 1
Wallner, Friedrich: Systemanalyse als Wissenschaftstheorie II: Kulturalismus als Perspektive der Philosophie im 21. Jahrhundert. Bern / Frankfurt / New York / Brüssel: Peter Lang, 2010. 2 Wallner, Friedrich: Acerca del Realismo Constructivo. Lecciones de Oviedo. Oviedo: Servicio de Publicaciones de la Universidad de Oviedo, 2013. B. Philosophical Materialism
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(German) 1 Holzenthal, Nicole: ”Gustavo Bueno“ in: Brockhaus Enzyklopädie. Jubiläumsausgabe, 21. Auflage, Mannheim / Leipzig: Brockhaus, 2005-2006. Bd. 5, S. 20. 2 Holzenthal, Nicole: ”Einführung. Der Philosophische Materialismus und Der Mythos der Kultur von Gustavo Bueno“ in: 3 Gustavo Bueno: Der Mythos der Kultur. Essay einer materialistischen Kulturphilosophie. Transl. by Nicole Holzenthal. Bern: Peter Lang, 2002. S. 9-29. (English) 4 Bueno, Gustavo: Sciences as Categorial Closures. Transl. by Brendan Burke. Oviedo: Pentalfa, 2013. C. About the Comparison Constructive Realism – Philosophical Materialism 1
Holzenthal, Nicole: “Die Kultur - ein Konstrukt“, in A. Schulz und F. Wallner (eds.): Construction and Interpretation Concepts of a Culturally Guided Philosophy of Science. Bern / Frankfurt / New York / Brüssel: Peter Lang, 2013. S. 147-169. 2 Holzenthal, Nicole: “Wissenschaftsphilosophische Fragen an den Philosophischen Materialismus und den Konstruktiven Realismus“, in A. Schulz und F. Wallner (Hrsg.): Aspekte des Konstruktiven Realismus / Aspects of Constructive Realism. Bern / Frankfurt / New York / Brüssel: Peter Lang, 2012. S. 179-204. 3 Holzenthal, Nicole: “Berührungspunkte und Kontraste zwischen dem Konstruktiven Realismus und dem Philosophischen Materialismus“, in K. Greiner und F. Wallner (Hrsg.): Aus dem Umfeld des Konstruktiven Realismus (Constructive Realism). Studien zur Wissenschaftskultur. Bern / Frankfurt / New York / Brüssel: Peter Lang, 2010. S. 165-187.
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Culture and Medicine in the Philosophical Materialism and Constructive Realism D. Images
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(1) Abby and Brittany Hensel (www.facebook.com/AbigailAndBrittanyHensel) (2) Kendra and Maliyah Herrin (www.facebook.com/pages/Herrin-Twins/56276037018) (3) A Maring warrior (4) Book cover of Rappaport, R.A. (1968): Pigs for the Ancestors. New Haven: Yale University Press, 19842, 198. (5) http://en.wikipedia.org/wiki/Mosquito (6) http://en.wikipedia.org/wiki/Plasmodium
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How can different medical systems be true at the same time? Popper, Feyerabend and Wallner about truth and method
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Andreas Schulz (University of Vienna)
All over the world there exist different medical systems with different concepts about health and disease, with different concepts of the human body and different methods of healing. These different medical systems depend on the presuppositions of different cultures, like for example Thai, Chinese, Islamic and European culture. Now the question emerges: What medical system is true? What is the right conception of the human body? What is the right treatment? But it is not possible to favor one of these different medical systems on the basis of rational arguments as they are all similar effective. These different systems have totally different views of the body and work with totally different healing approaches. But all of them are effective, all of them work, all of them heal diseases, all of them have their own rights. For example the Western medicine treats the body like a machine. On the contrary Chinese medicine understands the body as a system of energy. Western medicine is unable to treat chronic diseases sufficiently. But Chinese medicine is very good in treating chronic diseases. The philosophical question is: How can such totally different knowledge systems be true at the same time? How can they be at the same time scientific? In order to search an answer for this question I want to present some basic ideas of some famous Austrian philosophers about truth and method in science, namely Karl Popper, Paul Feyerabend and Friedrich Wallner.
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Maybe these questions are typically Western questions and do not make any sense from the view of Asian thinking. But even if so, it is important to discuss them. Otherwise a lot of Western people will have problems to understand the equality of the different medical systems.
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Popper’s idea of truth – approximation of truth by science Popper is an epistemological realist. That means he believes that with your theories we describe the structure of the real world. And he claims that this description may be in some cases better than in other cases. In scientific research we try to achieve step by step a better description of the world and that means to approximate truth. Of course Popper sees that we cannot know the truth, nevertheless he maintains the idea of approximation of truth. Hence, he speaks about relative closeness to truth. We can only find out the closeness to truth by comparing theories and not by comparing a theory with the truth. Because how could we compare a theory with truth if we don’t know truth? So if we compare two theories and find out that one of these theories can solve more problems than the other we are permitted to say that the theory which solves more problems is closer to truth than the other one. That way Popper believes that we come closer and closer to truth by the process of correction and replacement of falsified theories (see Popper 2005, 510–516).
Feyerabend’s abandonment of the idea of an approximation of truth According to Feyerabend there is no approximation of truth. The process of science does not show a sequence of theories which are getting better and better and are leading to an ideal theory. Rather knowledge is like an increasing ocean of incompatible theories. And even fictions and legends play an important role for the development of science. It is interesting that Feyerabend claims that a new scientific law is accepted by voting. Facts are not that important for the legitimation of a theory as Popper thinks. From facts we cannot derive theories. So Feyerabend does not agree with Poppers realistic theory of truth.
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So according to Feyerabend it does not make any sense to speak about truth. Truth is not more than a traditional idea (see Feyerabend 1986, 34, 211).
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Wallner’s critique of Popper’s absolute truth and of Feyerabend’s elimination of the discourse about truth Also according to Wallner it is nonsense to speak about an approximation of truth. Because how should we find out this approximation if we do not know the truth? So the hypothetical assumption of an approximation of truth has to be abandoned. Wallner also criticizes Popper’s idea of truth for its absoluteness: Popper seems to represent the traditional opinion that there is only one truth, that there is only one possible description of the world. Notably Popper does not see that there is not only one culture. He negates the manifold of the cultures. Popper does not see that different cultures have different sciences. Popper did not discuss this aspect in his work but today this is a fact that cannot be overseen. For example – and this is the occasion of our congress – we have different systems of medicine, which are all working. According to Popper it seems that foreign knowledge systems must be wrong. Poppers concept of truth is not able to explain the fact of the different medical systems in an adequate way. In contrary to that we must stress that according to the ideas of Constructive Realism there is not only one possible world representation. Rather we have many possible world representations. And different world representations have the claim of science and truth, not only one, not only the European science. Different to Feyerabend, Wallner does not eliminate the discourse about the concept of truth from the reflection of science and knowledge. According to Wallner we must keep a revised concept of truth in order to avoid arbitrariness. Otherwise science would lose its commitment. Otherwise science would be the same like fiction, legend and ideology. So Poppers idea of truth cannot help us regarding our main question: How can different medical systems be true at the same time? And Feyerabends elimination of the discourse about truth leads to the problematic situation that science loses its commitment, that science gets arbitrary.
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I will tell you more about the concept of truth from Prof. Wallner in some minutes. Just one hint right now. According to Prof. Wallner truth always is local truth. That means truth is always related to a certain context. Now I would like to tell you something about the methods suggested by Popper and Feyerabend.
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Poppers theory of falsification as an alternative to verification According to Karl Popper the verification of a theory is not possible. Single facts and even a huge amount of single facts cannot proof the truth or probability of a theory. In other words: Induction, the inference from single sentences to general sentences is impossible. Because theories are considered as general and therefore always claim more than single facts can show. The famous example of the white swans shows why verification is not possible. If you say “all swans are white” you can never be sure, that you will not find a black swan in a later time, in a different place. We cannot verify that all swans are white, but we can falsify that all swans are white if we find just one black swan. That way full verification is impossible, because in future it could be that you find a black swan. So verification depends on future experiences. That means we pretend to know what we cannot know. I cannot know what you will observe tomorrow, in one year or in ten years. That’s why Popper suggests to replace verification by falsification. Scientific theories are not built by induction, are not built by the inference from several single cases to the general proposition. Instead scientific theories are conjectures and inventions, which can be falsified by single cases or single facts. One single fact that is in contradiction to a general theory is enough to show that the theory is somehow wrong. Popper continues by postulating that a theory can only be called scientific if it can fail at the experience, if it can be falsified by facts in principle. That’s how he wants to differ between scientific and non-scientific knowledge. (see Popper 2005, 3–9)
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Pros and cons of Poppers falsification Falsification goes along with the idea of an open end of science One important advantage of the theory of falsification in contrary to the theory of verification is that falsification goes along with the idea of an open end of science whereas verification presupposes a final end of science. A final end of the science means that if the scientists are researching successfully then there must come a time, in which we will know everything which is important. In contrary open science means that there will be no end in science, that there will be no final knowledge, even not in 100 years or in 1000 years. With the theory of falsification Popper presupposed the openness of science. That is a good point. (see Wallner 2003, 7)
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Falsification cannot lead to truth But unfortunately he did not think this openness consequently. Because in some way Popper was convinced that we must make many falsifications and then we will arrive at a point of scientific evolution at which falsification is not needed anymore. And then finally we can say “this is true”. But the process of falsification is never arriving at a point at which you can say that something is true. If Popper would have been consequent, he would have thrown away his concept of truth (see Wallner 2003, 8). Falsification does not work Falsification is a perfect theory about the logic of scientific research, but it does not work in praxis, because facts are not strong enough to falsify a theory according to Feyerabend. And a lot of parts of science are not falsifiable. So it is nonsense in the opinion of Feyerabend that scientific theories must be falsifiable. So the theory of falsification would eliminate science as a whole (see Feyerabend 1986, 388).
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Falsification does not get used in scientific praxis Apart from that falsification does not play any role at all in the history of science. Every clever student of physics for example is able to cheat every falsification. What are the consequences if we concede that falsification does not work? One important consequence of the failure of Popper’s falsification is that we have to change the claim of science. We do not believe anymore that science is describing the world. Let’s assume that science is constructing worlds which are replacing the ontological world in some aspects. If you go to the labs of the scientists and discuss with them, you will see that the majority of their procedures have a constructive core. They are not describers, they are constructors.
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Feyerabend’s Contrainduction Like Wallner Feyerabend has the idea that the presuppositions of our own knowledge system cannot get visible from inside the system. In order to reveal them we need an external viewpoint, in other words a system of alternative assumptions. Therefore Feyerabend supposes to look for hypotheses which contradict our well-approved theories and facts. And to use anti-rules, which contradict the usual rules of scientific research. This suggested procedure, which is opposed to induction as well as falsification, is called Contrainduction. It is not the goal to replace the common rules by this Contrainduction. Rather the first goal of Contrainduction is to show that every science and every methodology has borders. The leading idea behind Contrainduction is that manifold of theories is fruitful for science (see Feyerabend 1986, 33-38).
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Critique of Feyerabend’s Contrainduction Contrainduction is not a good guideline, because it is too general According to Wolfgang Schelberger, who has compared the methodology of Constructive Realism with the methodology of Feyerabend, the Contrainduction remains to general. Feyerabend says that we have to search for anti-laws, for contradictory propositions wherever we find them. But this “everywhere or wherever” does not give an adequate guideline for the praxis of research (see Schelberger 2012, 298). Here the methodology of Constructive Realism, the Strangification, is much more concrete. It gives us the instruction to take only one or a few different knowledge systems in order to reframe parts of our system. Contrainduction leads to the idea of science without any commitment The even bigger problem with the Contrainduction is that scientific knowledge loses its commitment. That way scientific knowledge is devaluated as a whole. That is the negative, the unsatisfying relativism of Feyerabend.
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The difference between science and non-science is eliminated In connection with this Feyerabend speaks about scientific knowledge and nonscientific knowledge and claims that the latter has an important function in the Contrainduction. The problem is that scientific knowledge seems not to have more commitment than nonscientific knowledge. Thus Feyerabend denials the difference between science and non-science. According to Feyerabend there is no clear difference between scientific theories and legends. Science is only one of a lot of possible life-forms, and not the best. According to Feyerabend science does not have a particular methodology. The differentiation between science and non-science does not make any sense for him and does not lead to progress in knowledge (see Feyerabend 1986, 393). So in order to answer the question: “How can different medical systems be true at the same time?” we have to avoid Popper’s absolute realistic theory about truth on the one side and Feyerabend’s relativistic consequence, which makes scientific knowledge arbitrary, on the other side.
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Truth in Constructive Realism In traditional philosophy of science – for example for Popper – there is only one truth. True sentences are valid all around the world. But if you believe that there is an absolute truth, that a sentence has to be true in every possible world, then you are confronted with a lot of philosophical problems like: What is absolute truth? What are the conditions of absolute truth? etc. And you will not be able to answer the question: “How can different medical systems be true at the same time?” So we must introduce a new concept of truth, namely the concept of local truth and of relative truth, which has to replace the idea of absolute truth on the one side and the elimination of the discourse about the idea of truth on the other side.
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Local truth So let’s have a look at the concept of truth according to Prof. Wallner. If we regard the everyday use of the concept of truth we will see that the concept is always used in a specific context. If somebody tells me that they were in the cinema, then it is easy to decide whether they are lying or telling the truth, because the context is clear. I know what a cinema is and I know what it means to go to the cinema. The statement would not be true, if the persons did not watch a film and for example just went in and out of the cinema entrance. So we don’t have a problem with the concept of truth in the everyday use. The problem arises when we apply the concept to absolute assumptions. When we claim that a certain law in natural sciences is true in every possible world, then we have a problem. The meaning of every possible world remains unclear. The context of truth remains unclear, because we are unable to observe every possible world. In this case the concept of truth is separated from its context and according to Constructive Realism that is a mistake. According to Constructive Realism truth is a local concept. The concept of truth is local, that means it always depends on its context. A separation from its context leads to a malfunction of the concept and makes us believe something which is unclear and doubtful. The concept of truth only works if the context of its application is known.
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How can different medical systems be true at the same time?
According to Prof. Wallner a system of knowledge is true under specific conditions and these conditions are cultural. A sentence that is true in Europe may lose its truth in Asia and the other way round. Different cultural presuppositions found different ways of world views, and none of these cultural presuppositions is wrong or higher than another. It is only possible to judge a sentence or a knowledge system as true if we consider the founding culture of this knowledge. A scientific theory is related to presuppositions. But if you know these presuppositions, you know in which sense and with which limits a scientific theory is true. If you know for example what Thai medicine presupposes as body, you know in which sense and under which conditions Thai medicine offers true propositions. And if you know what Chinese medicine presupposes as body, you know in which sense Chinese medicine makes true propositions and so on (see Wallner 2010, 5-8). So if we want to investigate about the truth of our knowledge we have to research the presuppositions and the context of our knowledge. And that means first of all to reflect on culture. How can we do that? How can we observe the truth of a sentence or a knowledge system in connection with a certain context? How can we find the conditions of local truth? How can we reflect on culture? Of course it is impossible to step out of one’s own culture and to observe it from a kind of absolute view. However, we want to look at our culture from an external viewpoint in order to obtain critical insights in our culture. We want to see our own cultural presuppositions as if we were members of a different culture (see Wallner 2004, 3). We can achieve that by using the methodology of Constructive Realism, the methodology Strangification.
Method in Constructive Realism: Strangification How does Strangification work? The basic idea is that you take some propositions or a system of propositions out of their original context and put it in a totally different context. The more different the context is the better for the research. If you put some propositions of one context into another context the first thing that will happen is, that you cannot understand them anymore, that they get absurd. The reason is that they are missing certain presuppositions that are not given in the different context.
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And then you have to check, what you must change in the propositions in order to make them understandable again in the new context. If we want to make them understandable in the new context, we have to find out what are the implicit presuppositions of our original context. So in a strange context we can reveal the implicit presuppositions of our thinking. If we can reveal these presuppositions we make understandable what are the limits of our proposition system. And with these presuppositions we also get the conditions of truth (see Wallner 2003, 8-9).
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Examples for Strangification As we are in the Sigmund Freud Privatuniversität, I would like to give you an example for Strangification from the field of psychotherapy: For example a therapist of couples can ask the couple with problems in their relationship to put themselves with their problems into another time and perhaps also another place. With the help of this new context they see what is absurd or even funny in their old convictions, in their old views about the partner. Another example is the idea in TCM that there is heat in the liver. This is very astonishing for the western view, because the heat in the liver cannot be measured. This reveals the western presumption that theories must be based on measurable entities. Or for example you can take the theory of blood pressure from the Western medicine and take it in the context of Chinese medicine and then have a look what will happen. Or again the other way round: you can take the theory of the five phases from the Chinese medicine and put it in the context of Western medicine (see Wallner 2003, 8-9 and Wallner 2010, 6).
Relativity and Relativism If you don’t relate the scientific results to your own culture, if you don’t reveal the context of your results you cannot speak about truth. To relate scientific theories to the founding culture is the condition to obtain truth.
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How can different medical systems be true at the same time?
But if truth is relative we have to be careful that science does not get arbitrary, that science does not become a kind of fiction. Sure this view is a type of relativism, but not a kind of relativism that eliminates the concept of truth. Concerning science the thesis of Relativism is that there is not one right or true knowledge of the world because science also depends on culture. The danger of this view is that it destroys the commitment of science. Commitment – in German: “Verbindlichkeit” – is the demand that you cannot claim everything in science. Commitment also means that there must be some kind of difference between an ideology and science. Without commitment scientific knowledge is put on the same level as other forms of knowledge, like ideological, religious and also everyday knowledge. That way scientific knowledge turns into an arbitrary cultural product beside others. That is the form of relativism we have to avoid. Therefore Popper for example was strictly against cultural relativism. According to his philosophy of science there is a right view of the world. The relativism of Constructive Realism is a methodological relativism, which fights the idea, that science would describe the world that scientific theories refer to a world with stable structure. The liberal relativism in the philosophy of Constructive Realism is not an arbitrary world view, but the “conditio sine qua non” of understanding science. The change of cultures is the best way of understanding scientific knowledge. If we explain a theory to a person with a totally different background, then we will have to explain the presuppositions too. This explanation will offer new ways of understanding to us. In Constructive Realism relativism should be interpreted as relativity. “Relative” means “relational” in the context of Constructive Realism. That means the look to the relations is important. Strangification can be applied to scientific constructs in order to reveal their cultural dependency. Revealing the cultural dependency also reveals the locality of their truth. In this way the concept of truth is preserved. Only the illusion of an absolute truth is given up, by connecting truth with its context. To reveal the context of the specific truth of scientific products also has the effect that the scientific commitment is preserved. That way Constructive Realism clearly differs from cultural relativism or postmodernism, by preserving truth and commitment despite the acknowledgement of cultural dependence. So cultural dependence and commitment of scientific knowledge can go together. Thus cultural dependence does not mean that we are in a prison. In contrary: it means that we can strangifiy between different cultures and the understanding that is achieved in that way constitutes knowledge in the strong sense.
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Moreover the acceptance of the idea of different local truths which depend on their cultures is the condition of understanding and real knowledge. If we would not have different cultures we would not have the possibility to understand our culture. Because for understanding we need to observe our culture from the viewpoint of another culture by the help of strangification. So without the multiplicity of cultures we would understand nothing, we would not possess knowledge. That’s how the relativistic idea of different world views itself helps to overcome an absolute relativism, which would suspend any commitment of science. Therefore it is of great importance that the cultural diversity is maintained. We must give up the idea of the unification of all the cultures of the world. We have to avoid the desire to make all cultures equal. If there are a lot of different cultures there are a lot of possibilities to strangify and therefore to understand the different presuppositions of thinking. But if we had only one culture, we would understand nothing, we would not know anything. The different cultures are the condition for producing knowledge in a full meaning. If you are conscious that the other culture is needed for the understanding of your own culture, then you will respect the other cultures (see Wallner 2008, 3-6 and Wallner 2010, 1-6).
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As a summary: Some assumptions of Wallner’s Constructive Realism Science depends on culture – Science is a product of culture. The presuppositions of science come from the particular culture. Multiplicity of sciences – As there are different cultures there also exists a lot of different sciences. Popper did not see that. Feyerabend considered that, but he eliminates the commitment of science. In the sense of: “Everything goes” (but of course this is only a often misunderstood slogan). Sciences from different cultures have a totally different way of structuring the world Different cultures are different ways of structuring the world. Sciences which are based on these different ways of structuring the world must be totally different.
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Equality of sciences from different cultures – There is no ranking between different world views or different sciences. All of them have their equal rights. In order to make these assumptions understandable from the philosophical view we state that: Science is not a description of the real world (Wirklichkeit/environment). Instead science replaces the world or some aspects of the world by constructs or models. And there is not only one truth. Instead we have to assume that there a different local truths. A local truth is only valid for a certain context. In other words: The conditions of a local truth can be found in the respective context of a local truth. These conditions are cultural, depend on culture. In other words: The context of local truth is cultural. We can find out the conditions of truth with the help of Strangification.
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Only by knowing the conditions of truth of our propositions we can speak about knowledge in the strict sense. The existence of different cultures is the condition of the application of Strangification. The existence of different cultures is the condition of knowledge in the strict sense.
Conclusion Wallner’s Constructive Realism can be understood as a way to overcome Popper’s theory of absolute truth on the one side and Feyerabend’s relativistic theory of science on the other side. We can state: There are several different medical systems: Western medicine, Chinese medicine, Thai medicine, Ayurveda, Vietnamese medicine and so on.
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And these are different ways of explaining the processes of the human body. All of them work. So can we make a rational choice between them and answer the question which medicine is the better one? Of course not! It would be nonsense to say that one of the systems is right and the others are wrong. It is not possible to make a rational choice between them. It is only possible to understand the possible and impossible applications of these different medical systems, the advantages and disadvantages concerning the healing of certain sorts of diseases.
Literature
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1
Feyerabend, Paul (1986): Against Method: Outline of an Anarchist Theory of Knowledge. Frankfurt am Main: Suhrkamp. 2 Popper, Karl (2005): The Logic of Scientific Discovery. Tübingen: Mohr Siebeck. 3 Schelberger, Wolfgang (2012): die Verfremdung im Spannungsfeld der Methodologie des Radikalen Konstruktivismus und des Relativismus nach Feyerabend. In: Wallner, Friedrich / Lan, Fengli / Schulz, Andreas (Hg.) (2012): Aspekte des Konstruktiven Realismus. Frankfurt am Main: Peter Lang. 4 Wallner, Friedrich (2003): Strangification replacing Falsification. Unpublished lecture. 5 Wallner, Friedrich (2004): Culturality and Commitment. Unpublished lecture. 6 Wallner, Friedrich (2008): Culture and Sience. The Methodological Approach. Unpublished lecture. 7 Wallner, Friedrich (2010): Cultural Relativism and Cultural Absolutism. Unpublished lecture.
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North by Northwest: The Search for Objectivity in the Origins of Modern Western Medicine1
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José A. López Cerezo (Veliky Novgorod, Russia, Novgorod State University after Yaroslav-the-Wise)
North by northwest, as you all probably know, is an American Cold War thriller film directed by Alfred Hitchcock and released by MGM in 1959, with Cary Grant and Eva Marie Saint starring. It is a tale of mistaken identity, with an innocent man pursued “north-northwest” across the United States by secret agents of a mysterious organization. The film’s title is both obvious and obscure. It is obvious because of the geographical locations of the film, moving northwesterly from New York to Alaska (in the original script); and obscure because such a phrase, indicating some kind of detour, does not correspond to an actual compass direction. Hitchcock himself confessed in a 1963 interview to have taken the idea from Shakespeare, as a metaphor for the shifty nature of reality. “I am but mad north-north-west”, says Hamlet in Act 2 Scene 2.2 Things are not 1
The Research Project MICINN-12-FFI2011-24582 provided support for the development of this work. I also wish to express my gratitude to R. Mallet and the Direction des Services et des Réseaux of the National Library of France. 2 “I am but mad north-north-west: when the wind is southerly I know a hawk from a handsaw”, says Hamlet in Act 2 Scene 2 to his false friends Rosencrantz and Guildenstern. The usual meaning attributed to this passage is that birds use to fly with the wind. When the wind is northerly the sun dazzles the bird’s eye and it is difficult to distinguish one bird from another. But if the wind is southerly, and the bird’s back is to the sun, it is easy to distinguish a hawk from a handsaw (probably a corruption for hernshaw – a kind of heron). Thus Hamlet seems to say that he is mad only in certain situation or at certain times, with some “method” at the service of his purposes (e.g. http://www.shakespeare-online.com/plays/hamlet/examq/six.html;
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necessarily what they look like; and the access to shifty reality may sometimes require go north by northwest. This is also a metaphor for the search for objectivity in the origins of modern western medicine. In this article I will critically analyze a key turn concerning the significance of clinical information which took place in the rising of modern western medicine during the so-called anatomical-pathological revolution in early 19th-century. From the view point of its instrumental and contextual determinants, I will review the conceptual transformation of nosology and clinical history in the search for objectivity and a firm scientific basis for the new medicine, particularly in the work of a main actor of such transformation: the French physician René Laennec. The objectivization of medical expertise and the consolidation of the ontological view of disease will also be analized as constitutive dimensions of such a process in the rising of present-day medicine. The theoretical framework adopted corresponds to the naturalistic conception of the philosophy of science, as found in the approaches of authors such as H. Longino, I. Hacking, M. Salomon or P. Thagard.
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Invention and consolidation of the stethoscope One of the most representative authors in medicine at the start of the 19th-century was the French physician, trained as a surgeon, René Laennec (1781-1826). The main contribution for which Laennec is known in the history of medicine is for the invention of the stethoscope in 1816, while he was examining a young woman with general symptoms of heart disease at Hôpital Necker in Paris. Attention to the diffusion of this instrument will be useful to understand the way in which disease was conceptualized at the outset of scientific medicine, as well as the value of instrumentation and disciplinary standards in clinical observation during the period in question. Laennec made his results public in his De l’auscultation médiate ou traité du diagnostique des poumons et du coeur, published in 1819, in which, as in other parts of his works, he attempted to make clinical practice more rigorous by basing it on the natural sciences (Birtalan, 1982). The book, which was sold together with the new instrument, was well-received from the moment it was published (Kervran: 1960: 153). Besides the mediate, or indirect, auscultation access: 26-07-2013).
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technique,3 Laennec accurately described diverse thoracic affections and offered new clinical- pathological analyses of bronchial ailments such as emphysema, pulmonary oedema and pneumonia, although his greatest contribution was his study of pulmonary tuberculosis. Tuberculosis was responsible for a high percentage of deaths in 19th-century Europe, as in the preceding centuries. In the days of Laennec, pulmonary tuberculosis was known as phthisis or consumption, as the disease consumed its victims little by little until they finally died. As opposed to his contemporaries, Laennec defended the specificity of tuberculous lesions and the possibility of spontaneous cure in certain cases. Relying on auscultatory exploration, he described the different forms of tuberculosis and their corresponding lesions, while introducing order into the chaotic pulmonary pathology of the age, as well as hygiene and decorum in medical practice.4 The stethoscope became a useful clinical instrument due to the possibility of relating two series of phenomena: on the one hand, the characteristic anatomical lesions of the different cardiac and pulmonary diseases and, on the other hand, the corresponding auscultatory sounds. In fact, Laennec’s work was guided by the heuristic principle of “one sign-one lesion”.5 In order to link both sets of phenomena, he devoted himself to the painstaking empirical task of compiling and clarifying the extraordinary number of sounds which may be heard when auscultating the human thorax, reducing multiform sounds to their sonorous elements and relating these to elemental anatomical lesions. 6 The Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
.
3
Laennec took the term “auscultation” from Régis Buisson, who, in 1802, introduced the distinction between two methods of listening: a passive way called “audition” and an active way called “auscultation”. See Lachmund (1999: 443). 4 In his (1960: 134-148), R. Kervran describes the state of chaos in which pulmonary pathology was then immersed. For example, in 1817, lung cancer, lung abscesses and bronchial emphysema were commonly confused with varieties of tuberculosis. He also emphasizes the importance which the considerations regarding hygiene, convenience and decency had in the invention and diffusion of the instrument. 5 Laennec was, however, aware of the fact that a serious disease might lack an evident or symptomatically-manifested organic lesion. See Duffin (1998: 173, 202). 6 The result of this sign-lesion correlation was, in the words of López Piñero, “the set of auscultatory sounds which, with practically no modification, continues to form part of current semiology: the vesicular, bronchial, cavernous and metallic breath sounds, bronchophony, pectoriloquy and egophony, the different crackles and wheezes (crackling, bubbling, sibilant, ronchus, etc.), amphoric buzzing, metallic tinkling, friction rub, cardiac click, diastolic and systolic sounds, diverse heart murmurs, crackles, thrills, etc.” (1985:
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proper use of the apparatus thus made linking lesions and signs possible, giving it a diagnostic and prognostic value, and guaranteeing its good performance through autopsies – “convincing us through our eyes of the accuracy of the signs which our hearing gives us” (Laennec, 1819: 14). For Laennec, alterations in the organs which appear as anatomical lesions are the physical expression of disease understood as function disorder, and auscultatory signs are the manifestation of these alterations. After Laennec’s contribution, tuberculosis was “unified” so that phthisis or consumption, on the one hand, and the anatomical presence of tubercles, on the other, were associated as two aspects of one and the same disease (Duffin, 1998: 156-7). The reliability of auscultatory signs, according to Laennec, depended on two independent qualities: specificity and sensitivity. A sign is specific if it is invariably associated with one, and only one, type of lesion, in such a way that one cannot be present without the other. A hardly-specific sign produces false-positives,7 which Laennec personally abhorred. A sign is sensitive if it is always present and is detectable when a lesion is produced, no matter how weak this may be. Lack of sensitivity produces false-negatives, which Laennec considered more tolerable than false-positives. As Jacalyn Duffin states, Laennec’s signs were little theories about the condition of his patients; they were more than sounds, “they incorporated visualization, imagination, calculation, and theory” (1998: 201-2). Contrary to audition (passive perception, listening) and immediate auscultation (active perception), stethoscopic auscultation is an active, instrumentally mediatized way of producing clinical data. The instrument, and its accompanying technique, was finally consolidated with the work of Joseph Skoda (1805-1881), an important author in the evolution of clinical diagnostics. Skoda, an internist at the General Hospital of Vienna since 1832, published his work 20 years after Laennec’s treatise: Abhandlung über Perkussion und Auskultation (1839). Skoda remained faithful to the anatomical-pathological tendency which was the basis of his work on mediate auscultation, attempting to offer a new classification of the sounds subordinate to a scientific explanation of their anatomical origin.
37-38). 7 A false-positive is a type-I error, which consists in incorrectly rejecting the null hypothesis, i.e. the hypothesis which states that there is no relation between two variables. A false-negative is a type-II error, which consists in incorrectly accepting the null hypothesis.
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Nevertheless, it must be pointed out that there exist discrepancies between the approaches of Laennec and Skoda concerning the classification of auscultatory sounds; even while both formed part of the same anatomicalpathological school, they gave rise to two different traditions in the French and German medical milieus (Lachmund, 1999: 427 ff.). For Skoda, as opposed to Laennec, auscultatory signs should be based on acoustic principles and supported by a program of experimental research. As a result of requiring this physical explicability, the “one sign-one lesion” methodological principle was abandoned and a lesser degree of taxonomic refinement was achieved. These differences also reveal the “interpretative plasticity” (of the auditory experiences) which is found in the origin of the use of the stethoscope, as well as the importance of standardization as a universalizing mechanism for knowledge and regulation of the practice. The history of the stethoscope, to this effect, is also a process of standardization of perception8 which, according to Lachmund (1999), led not only to the reconfiguration of the objects of medical knowledge, but to new standards of perceptive competency in medical professionals as well. After its invention in 1816, and especially on account of the contributions made over the following decades by authors like Skoda, the stethoscope was quickly consolidated as a key instrument in medical practice and research. With the aid of the stethoscope, physicians were able to gain direct access to information inside the body; they were able, in a manner of speaking, to perform an autopsy while the patient was still alive. It was able to extraordinarily increase the possibilities of the method of anatomical- pathological correlation, allowing diagnosis and prognosis, as well as, as Rusell Maulitz states (1987: 100-101), a certain degree of therapeutic intervention.
The anatomical-pathological revolution The stethoscope is also the best testimony to the prevailing medical paradigm arising during the 19th-century. Actually, Laennec was a key figure of the anatomical-pathological revolution which, according to common understanding, placed medicine on the map of the sciences (Laín Entralgo: 1978: 464 ff.). This 8
This is what, shortly before the invention of the stethoscope, J. Corvisart called l’éducation médicale des sens, with regard to the need to foment and standardize the semiological value of percussion. See Laín Entralgo (1950: 281).
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was a change in worldview, produced when medicine was shaken by the most famous of political revolutions: the French Revolution of 1789.9 In the words of López Piñero:
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“It is not by chance that the original stage for anatomical-clinical medicine was precisely that of post-revolutionary France. For obvious reasons, the new economic, social and political structures offered the appropriate conditions for producing a decisive rupture with medical tradition... In order to eliminate the dead weight of the ancien regime, the [medical] profession and teaching, scientific institutions and hospitals were organized on completely different bases. There was a desire to create a new Medicine and this reorganization managed to put an end to the separation between physicians and surgeons, imposing instruction of a fundamentally practical nature and making hospitals the centers of medical life. All these were factors that weighed decisively on the appearance of the anatomical-pathological school, which would make the program of radical renovation a reality …” (1985: 13).
Neither was it by chance that the pioneers of the medical revolution were surgeons or physicians with surgical training in the France of the time: Xavier Bichat, Jean Corvisart, Gaspard Bayle, René Laennec, etc. For these authors, disease should be conceptualized in terms of pathological lesions in tissues and organs, and medicine itself should focalize on the structural alterations or anatomical lesions which autopsy reveals after death, to later relate this knowledge to data from clinical observation.10 “Open up some cadavers: you will immediately dissipate the darkness that simple observation could not make disappear”, said Xavier Bichat, one of the leaders of this revolution, in 1802.11 From that point on, disease started to be understood not as a matter of fluids unbalance or a bunch of symptoms, but as local lesions within the human body and to be classified according to the pathological alterations evidenced in the autopsy (Lachmund, 1999: 423). As Rusell Maulitz indicates (1987: 227), physicians and surgeons of late th 18 -century Europe were different subcultures, each with their own codes and 9
See, in general, Faure (1994: chs. 4 and 5). See López Piñero (1985: 11 ff.), and Maulitz (1987: ch. 1). 11 Quoted in Lindemann (1999/2001: 69). Besides Xavier Bichat (1771-1802) in France, other precursors of pathological anatomy are the Italian, Giovanni Morgagni (1682-1771), a professor at the University of Padua to whom the foundation of pathological anatomy is usually attributed, and the Scot, Matthew Baillie (1761-1823). 10
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symbols and each speaking distinct dialects as regards the human body. For surgeons, with an approach based more on craft and lacking the social prestige of physicians, the body was a mosaic of individual parts. Most of the diseases subject to their attention, such as inflammations and gangrene, were targeted for one of the two standard surgical interventions: excision or amputation. For physicians, the body code was another: interdependent regions linked by fluids which transported substances responsible for the well-being or weakening of the body’s economy, an economy which was expressed symptomatically. The convergence of these two cultures, with distinct visions regarding disease, involved institutional and professional changes as well as changes that were conceptual in nature and relative to intellectual resources. This is what Maulitz (1987: 228) terms the creation of a new “body grammar”: something towards which Bichat took a decisive step and which triumphed with the work of Laennec. The intellectual core of the anatomical-pathological revolution was the transition from clinical symptomatology to pathological anatomy in the conceptualization and classification of disease. Following the physicians’ grammar, until the 19th-century, diseases were classified on the basis of the changes they produced in the human body, that is to say, on clinical symptomatology, which in turn had displaced the humoral theory of the Hippocratic-Galenic tradition. One of the main driving forces behind symptomatological nosology was the English physician, Thomas Sydenham (1624-1689). Syndenham lent great importance to observation and experience, shunning theory and causal conjectures, and considered each patient to be a dynamic entity in which disease manifested itself individually. Fighting against disease was akin to combating dysfunctional symptoms and the task of the medical scholar was to identify diseases through their characteristic clinical histories in order to later associate them with specific therapies. The observation involved in medical research is that characteristic of Baconian botanical observation: careful observation of numerous cases, exclusion of odd cases (“tricks of Nature”), description of similarities (identification of “constant symptoms” in a certain temporal order) and classification by type or “morbific species”.12 Diseases are thus understood as “morbific species”, as regularities of 12
See Laín Entralgo (1950: 144). One of the most influential classifications in symptomatological nosology was precisely that of the physician and botanist, François Boissier de Sauvages, who, in his Nosologia methodica (1763), differentiated 10 classes, 40 orders,
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Nature with characteristic clinical histories, symptomatically expressed, which are repeated from one patient to another. In opposition to this tradition, the new “body grammar” emerging at the start of the 19th-century began to characterize diseases in terms of the internal structural lesions that they produced, which were revealed through autopsy. The anatomical lesion came to constitute the basis for pathology and clinical practice, overcoming the traditional subordination of these with respect to the symptom. Methodologically speaking, it was a question of moving from a traditional approach based on generalizing inductive practice to one founded on the introduction of causal hypotheses about the seat of disease, thus subordinating the symptom to the lesion (Simon, 2011: 70). In the suggestive words of Foucault: “... medical experience will substitute the localization of the fixed point for the recording of frequencies. The symptoms of pulmonary phthisis include coughing, difficulty in breathing, marasmus, hectic fever, and sometimes purulent expectoration; but none of these visible modifications is absolutely indispensable (there are tubercular patients who do not cough), and their order of appearance is not strict (fever may appear early on or only towards the end of the evolution of the disease). There is only one constant phenomenon, the necessary and sufficient condition for the presence of phthisis: lesion of the pulmonary parenchyma ... Above this fixed point, the symptoms slide and disappear ... ‘Individuals must be regarded as phthisic,’ he continues, quoting Bayle, ‘who are neither feverous, nor thin, nor suffering from purulent expectoration; it is enough that the lungs should be affected by a lesion that tends to disorganize and ulcerate them; phthisis is simply that lesion.’” 13
Laennec himself defended the new approach in an analogous way: “Pathological anatomy is a much more reliable science and presents more distinct objects of study than symptomatological nosology. It is, for example, much easier to describe tubercles and relate their signs in detail than to define the disease solely on the basis of its external symptoms, to then order its varieties according to their causes” (1821: xxxi).
295 genuses and 2,400 species of disease (cf. Reiser, 1978: 9-10). 13 Foucault (1963/2003 : 169-170). The quote corresponds to G.L. Bayle, Recherches sur la phthsie pulmonaire, Paris, 1810, pp. 8-9.
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What were seen from the extreme empiricism of symptomatological nosology as collections of specific symptoms, pertaining to the “nature” of each morbific species (Laín Entralgo, 1950: 145), from the hypothetical-causal view of the anatomical-pathological approach were considered simple external manifestations of organic lesions defining the disease. It is worth pausing now to discuss a question of terminology, which summarizes the rivalry between these two medical traditions. Laennec called any disturbance in biological functions a “symptom” and understood such disturbances to be the consequence of a fundamental organic lesion. He distinguished between two classes of symptoms: the “moral” or psychic (such as anxiety or moaning in pain), which would be the psychological correlate of the disease, and the “physical” or corporal (such as fever, vomiting or coughing), which would be the somatic manifestation of the disease. As far as “sign” is concerned, he considered it to be all the sensorial data which allowed the existence or the properties of this anatomical lesion to be inferred. All things considered, from the point of view of Laennec and the anatomical-pathological tradition, the fundamental difference between symptoms and signs lay in their semantic value as evidence for the observer of disease (Foucault 1963/2003: 110). For Laennec, the intentionally triggered sign, that is to say, the empirical evidence proceeding from exploration, constituted “the most positive and least variable phenomenon” of the disease (Laennec, 1819: Prologue). In contrast, symptoms were variable for each disease, too general (they could be common to several diseases) and misleading in their reading. By means of the physical sign, the physician could diagnose the disease and anticipate its development, that is, the course of the disease could be “seen”: oedema zones, formation of effusions, cardiac dynamics, etc. (Laín Entralgo, 1950: 307). The above reasoning resulted in his disdain for the symptom and regard for the sign, which established the link between the anatomical lesion and technically-aided exploration. Laennec criticized the variability of the simple co-variation on which the traditional approach was based and defended the need to introduce those causal hypotheses where reference was made, not to the origin or ultimate causes of the diseases, but to anatomical or physiological determinants on which the latter depended (the sedibus morborum or seats of disease, in Giovanni Morgagni’s words).14 14
Caution must be exercised with the causal subject in this tradition. For example, Russell Maulitz states in this regard, referring to the approach by G. Bayle: “The anatomical
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Hence lies the importance of the invention of the stethoscope for a trained surgeon and anatomist like Laennec. Stethoscopic auscultation made it possible to perform a virtual autopsy, thus extending the study of pathological lesions to patients who were still living, allowing physicians “to make the invisible visible” (Foucault, 1963/2003: 110). By means of the stethoscope, as provider of pathological signs, the anatomical lesion was able to fully assume the explanatory role which it had lacked until then. Until the 19th century, the anatomical lesion had been limited to being a “confirmatory or rectifying finding”, in the words of Laín Entralgo (1950: 198), but always a posteriori or post mortem. Since the invention of the stethoscope, the anatomical lesion was to acquire diagnostic and prognostic value, and was to become the basis for nosology and medical knowledge. As Lachmund states, “seeing pathological objects in the dissection room and hearing sounds and murmurs at the sickbed thus became complementary modes of ordering medical reality" (1999: 423). The parallel development of laboratory medicine during the 19th century likewise offered soundness to the anatomical-pathological program through the appearance of new techniques for the detection of physical signs and the anatomical-pathological redefinition of old diseases. For example, in Richard Bright’s redefinition of “renal dropsy” as “albuminous nephritis”, the possibility of detecting albumin in the patient’s urine by means of a chemical test allowed the lesion of an internal viscera, inaccessible to direct exploration, to be clearly evidenced, thus being able to dispense with the symptomatological charaterization of the disease. This line of medical research permitted raising laboratory data to the category of physical sign (Laín Entralgo, 1950: 324). The classification of diseases in terms of anatomical lesions rather than symptoms or balances of fluids certainly involved a profound conceptual change in the evolution of medicine. It instances the greatest of the types of conceptual lesion ... establishes the class and possibly the specific type of a disease entity, but not its origin. Final causes must remain obscure. So, too, must immediate causes. It is often impossible to state the nature of the terminal event; only the organic lesions that (presumably) preexisted are discernible, and it is assumed they become causes of death only through some sort of mediating mechanism. Only rarely are the organic and inciting (that is, inciting to death) lesions one and the same ...” (1987: 81-82, italics in the original). See also Laennec (1819: xx ff.) and Laennec (1821: 55), who assumed a position analogous to that of Bayle. Thus it appears that, in this tradition, the most common understanding of “cause”, when referring to the anatomical lesion as seat of disease, was that of “contributing necessary condition”. See Duffin (1998: 205-206), and Lachmund (1999: 424).
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change identified by P. Thagard in How Scientists Explain Disease (1999: 150): tree switching, that is, changing the organizing principle of a hierarchical conceptual tree. The anatomical-pathological approach clearly implies what Kuhnian terminology would describe as a Gestalt shift, categorizing the available empirical evidence, data from clinical observation, in a new way, as well as broadening (and correcting) that traditional empirical base through exploration via autopsy and stethoscopic auscultation. As pointed out by W. Stempsey: “The choice of a nosology will have important ramifications, not only medical but also social and economic. Nosology is often forced into service as a lingua franca for different worldviews” (1999: 152). As cornerstone of both medical knowledge and professional activity, substantial changes in nosology, in the ways of producing data and in their interpretation, amounts to a profound transformation in medical theory and practices (in physiology, in clinical medicine, in therapy, etc.). The predominant clinical-nosological paradigm of pathological anatomy thus constituted a methodological framework which afforded visibility to a certain class of phenomena, physical signs, highlighting them as significant. It emphasized a certain kind of practice, anticipated anomalies and offered indications as to the way of developing theory and healthcare. The anatomical lesion, the autopsy, the association between lesions and signs, as well as the physical explanation of these associations (in the tradition of Skoda) were especially the main principles or disciplinary standards of the anatomical-pathological approach in medicine, all within the framework of a hospital organization appropriate to the “body grammar” of the new medicine.15
15
The political antecedents created the circumstances which made the anatomical-pathological revolution possible, but its consolidation was to depend upon the effective transformation of the socio-professional context of medicine at the time in keeping with the disciplinary standards of the new approach, including such aspects as the division of medical work, the structure of clinical histories, instrumental support in hospital research, the favored lines of research, epidemiological planning, the routines of medical care and even the physical distribution of hospital wards. In fact, this reorganization in hospital care and the anatomical-pathological approach itself jointly evolved from the association of surgery and medicine and the conversion of the hospital from a place where patients with no other recourse were admitted for observation and care to a teaching and testing center – the birth of the clinic (see Bowker and Star, 1999: ch. 1).
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The objectivization of disease Trying to provide a firm basis for medicine, and transform it into an objective, positive science is a central aspect of the anatomical-pathological revolution. Let us now consider how the project of a medicine based on physical signs was also a project for providing objectivity to medical knowledge. The search for objectivity has been traditionally understood as a central undertaking of empirical enquiry and scientific knowledge. In its most general epistemological sense, the question of objectivity refers to whether humans are capable of knowing reality as it truly is, or whether there exists some kind of necessary distortion in our capturing of reality (in our perception or understanding), dictated by the nature of the human cognitive system or by other factors such as culture, ideology, psychological elements or dominant paradigms (Machan, 2004: vi). Allan Megill (1994) distinguishes four senses of “objectivity”: the absolute or philosophical sense (capturing things as they really are – the “view from nowhere”), the disciplinary sense (which takes consensus among members of a community as the standard for objectivity), the interactional or dialectical sense (objects are constituted as such in the course of interaction with subjects) and the procedural sense (associated with the practice of an impersonal method of research). Instead of single notions, these are really families of closely related notions, with differences in emphasis but also with clear links among one another. Interesting for us are the dialectical and the procedural senses. Concerning the procedural sense, this is a modification of the absolute sense and has been the prevailing one in 20th-century philosophy of science, along with the positivist project of developing a “scientific philosophy”. Here, the defence of objectivity has traditionally been expressed in a procedural manner, in terms of the availability of an impersonal method of justification, which safeguards knowledge against subjectivity and other sources of bias. The ideal of scientific objectivity has thus been linked to the existence of a method that provides non-arbitrary, non-subjective criteria to accept or reject claims to knowledge. Ascribing objectivity to a field of knowledge in this sense is to assert that its findings are based on the application of a procedure of this nature.16 16
The classical literature in the philosophy of science provides several well-known models of “rational consensus formation” as candidates for this procedural criterion, ranging from the verification or probabilistic criteria postulated in positivism and Popperian falsi-
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As to the dialectical sense, this implies a positive attitude toward subjectivity, for subjectivity is recognized as a necessary condition for objectivity. Contrary to the absolute or disciplinary senses, the dialectical sense does not seek to exclude or cancel subjectivity but to include it, emphasizing “doing” over “viewing”. Along the pragmatic and phenomenological traditions, and gathering authors as diverse as M. Heidegger, M. Polanyi or A. Pickering, this notion raises a historical, processual notion of objectivity where objects are known to us, not by theoretical contemplation, but in the course of our action in the world. Thus, objectivity is not a virtue of a system of bias cancellation or of particular methods of research, but a result of a process of knowledge production involving an active subject.17 Based on the above background, the advent of modern-day western medicine can be described as the transition from a dialectical conception of objectivity (Hippocratic-Galenic tradition and symptomatological medicine to some extent) to a procedural view of objectivity which starts with the anatomical-pathological tradition and is further on consolidated along with the increasing technification of healthcare to the present day. In pre-modern medicine, diagnosis was conceived as a process of interaction between the physician and the individual manifestation of a disease in the patient, including the careful report of symptoms by the sick person. It is a processual, dialectical way of knowledge production, not based on impersonal procedures but on subject-object interaction. In modern medicine, objectivity is grounded on the application of certain method for gathering impersonal information - an information coming from the disease itself and not from an elusive subjective report (see below). In this sense, the particular procedure followed for reaching certain result (the physical sign) is what offers us guarantees of grasping reality and avoiding appearances (symptoms), that is, the technical proxy for objectivity. The distinction between objective signs and subjective symptoms echoes an old philosophical distinction that has formed part of the creation of modern science, that is, the distinction between primary and secondary qualities. This is a conceptual distinction about the nature of reality which originates in classical ficationism through to the more recent post-Kuhnian criteria, which are non-hierarchical in nature and contain several axiological levels (e.g. Laudan, 1984; and Shrader-Frechette, 1989). See notwithstandind the more recent disciplinary approach of naturalistic authors such as Longino (2002) or Solomon (2000). 17 This also echoes a particular view of Kant’s theory of knowledge and his defense of categories for understanding (Megill, 1994: 10). See also Fabian (1994).
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Greece. Primary qualities are qualities of objects independent of perceiving subjects, such as extension, form or movement. They are supposed to exist in the things in themselves, as measurable and objective aspects of physical reality. In contrast, secondary qualities as color, sound or smell are qualities of things as long as these are perceived by observers, for they are linked to sensory impressions in the observer and, as such, are subjective.18 This old philosophy, rooted in the atomism of Leucipus and Democritus, was vindicated in Renaissance and the origins of modern science along with the anti-Aristotelian reaction of this period (Aristotle was very critical with the mechanistic view of reality promoted by Greek atomism). Descartes, Galileo, Locke or Newton were well-known promoters of a scientific method and worldview inspired in the old Greek distinction. Such a methodical searching for reality behind appearances is still a common ground some centuries after Galileo and the triumph of modern science worldview (e.g. Shepherd, 2011) – a ground where medicine eventually found its place in early 19th-century. But this implementation of a procedural view of objectivity, based on clinical protocols, instruments and laboratory tests, so as to achieve epistemic guarantees of faithful clinical information through a certain technical detour, also contributed to the reification of disease and the transformation of clinical practice. Let us examine now these other aspects of the anatomical-pathological revolution, which may be termed the “de-personalization” of disease and the “de-subjectivization” of medical information, along with the transformation of the physician-patient relationship induced by these changes. The development of the anatomical-pathological view of disease and the instrumentalization of medicine signified, in the first place, the consolidation of an “ontological” notion of disease, as opposed to the traditional “functionalist” notion (Lindemann, 1999: 2-3). This actually involved a process which began with the symptomatological definition of disease favored by 17th-century physicians like Sydenham, with his botanical attitude in nosology which placed objective observation and classification above past medical authority (Stempsey, 1999: 100-102). This ontological view was given a boost by medical instrumentalization and culminated with the later etiological view of disease, the development of microbiology and the improvement in public health care at the start of the 20th 18
In an analogous sense, it must be mentioned the distinction introduced by Arthur Eddington in 1927 between his famous two tables, between the scientific image and the manifest image later on dubbed as such by the American philosopher Wilfrid Sellars.
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century. Since the so-called ontological approach, diseases have become “de-personalized” and “reified”: every disease is considered as a real entity existing independently of the identity of the affected subject. On the contrary, from the functionalist (or nominalist) viewpoint, disease was understood as a dysfunction resulting from personal habits or from the particular action of the environment on the individual. It placed emphasis on the functional and dynamic nature of disease, so that it denied the existence of diseases as abstract entities (Stempsey, 1999: 103-109). The functionalist notion represents the classical conception, linked to the Hippocratic-Galenic tradition, which maintained significant influence over Western academic medicine until well into the 18th-century.19 According to this tradition, diseases were specific to individuals, affections resulting from the actions of environmental agents which caused the humoral imbalance of an organism with its own constitutional idiosyncracy. Consequently, treatments were also highly individualized, acting allopathically on the symptoms, as the idea was to restore that particular balance of humors in each individual human being. Disease did not exist as a specific pathological entity in itself, such as it has been understood ever since the consolidation of the ontological conception.20 A second interesting consequence, related to the previous one and the procedural search for scientific objectivity, deals with what may be called the “de-subjectivization” of medical information promoted by the diffusion of the stethoscope, as the spearhead to a later process of growing instrumentalization and technification in medical practice (Faulkner, 2009). As Jacalyn Duffin states in her biography of Laennec: “In Laennec’s lifetime, disease concepts changed from constructs based on patient’s subjective symptoms and feelings, described in the patient’s history, to concepts based on specific changes in the patient’s body, detected objectively through physical examination” (1998: 25).
19 There are, of course, important exceptions, beginning with the Swiss physician, Paracelso (c. 1493-1541), forefather of symptomatological nosology. Parecelso understood disease as a real entity which existed independently, as the result of the organism having been invaded by an external entity (the arqueo – a kind of spiritualized poison). See Lindemann (1999: 4, 69 ff.). 20 See in general Simon (2011).
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The particular effects of the stethoscope are documented by Stanley Reiser in his classic Medicine and the Reign of Technology: “... [mediate] auscultation helped to create the objective physician, who could move away from involvement in the patient’s experiences and sensations, to a more detached relation, less with the patient but more with the sounds from within the body. Undistracted by the motives and beliefs of the patient, the auscultator could make a diagnosis from sounds that he alone heard emanating from the body organs, sounds that he believed to be objective, bias-free representations of the disease process” (1978: 38).
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This growing differentiation between subjective symptoms and objective signs in fact constitutes a tendency associated with the implementation of the anatomical-pathological approach at the beginning of the 19th century, of which Laennec formed a fundamental link, but which has important precursors in other French physicians who accompanied him in this revolution. For example, Laennec’s mentor, Jean Corvisart, used profusely the technique of percussion as a source of reliable medical information, differentiating between the homme physique and the homme morale. Dividing patients in this manner allowed him to group clinical information into three categories: “... the ‘sure and constant signs’, univocal with respect to their immediate cause; the ‘moral man’s’ expressions regarding disease, essentially ambiguous, variable and suspect; and, between the latter and the former, the organic symptoms which, like vomit and fever, lack a fixed and known semiological significance” (Laín Entralgo, 1950: 281).
The triumph of the anatomical-pathological paradigm and the instrumentalization of medical practice also brought about quite a significant change in physician-patient relations. In the symptomatological approach during the 17th and 18th-centuries, the center for medical practice was the home, either the physician’s or the patient’s, but not the hospital. The patient was a patron, not a client (Lindemann, 1999: 221-2). The physician examined the patient’s external appearance and fluids, asked questions and listened carefully to the patient’s personal narration of the symptoms. The change of paradigm and instrumentalization would suppose that medicine dealt with disease, not with patients, and that what patients knew and felt was not very reliable, whereas the information ob-
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tained from technical exploration or laboratory analysis was very much so.21 While healthcare turns into technical healthcare, one might say that the subjective individual is lost in the search for the objective disease (see Bluhm and Borgerson, 2011: 214 ff.). These were ideas which would gradually become consolidated with each new apparatus and technology that, in the procedural search for scientific objectivity, has been added to the medical instrumentarium since then.22
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Concluding remarks The invention of the stethoscope allowed for the broadening of the observational base in medical practice and research, but the fruitful use of this and forthcoming instruments presupposed a certain conceptual innovation with regards to the characterization of disease: a reifying nosology built upon a certain type of causal hypotheses and the technical production of clinical data. A procedural conception of objectivity, according to the standards of modern science, put under new light the significance and value of medical information along this process. In turn, the conceptual and technical change, and the reclassification of clinical data on such basis, involved and presupposed contextual and organizational changes in the medical profession. These were changes related to the new line drawn for disciplinary frontiers (the fusion of medicine and surgery) and the reorganization of healthcare, which were to evolve jointly with the new disciplinary standards and techniques eventually placing medicine on the scientific map. But what is the cost? We have been using Hitchcock’s film as a metaphor for reflecting on the “social epistemology” of the stethoscope. It is a good film indeed, with a strange and suggesting title. Go north by northwest in the advent of modern western 21 See in general Reiser (1978) and Postman (1992). See also Illich (1976), Collins and Pinch (2005), Foucault (1963: ch. 9) and Stempsey (1999: ch. 6). 22 See Reiser (1978: ch. 1). An antecedent of the stethoscope which provoked the same type of criticism in obstetrics was the forceps, which came into general use in 1723 (Beauvalet-Boutouyrie, 1999: 178). As to the prevalence of technology in modern medicine, the World Health Organization offers a comprehensive view of medical devices, including in them “any instrument, apparatus, implement, machine, appliance, implant, in vitro reagent or calibrator, software, material or other similar or related article” used in healthcare (drugs are excluded) (quoted in Faulkner, 2009: 30).
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medicine? After all, it makes sense to try achieving objectivity by means of a detour, to try grasping the nature of disease while avoiding the deceitful straight road: symptoms – the prima facie manifestation of disease. For it is not symptoms but signs, through a technical detour, that seem to offer us epistemic guarantees as transmitters of faithful clinical information. However, it is important not to forget that a procedural approach, just as a bureaucratic method, offers a warrant for rigor, fairness or impartiality, not necessarily for truth (Porter, 1994). As it happens in Hamlet’s quote which gives inspiration to the title of Hitchcock’s film, one can get somehow off the mark by heading north-north-west, one can get dazzled by the instrumentarium and techniques and lose the human referent, projecting the objectivity of technically constructed signs into its ultimate source: disease in itself – the sedibus morborum. The de-subjetivization of medical information, the objectivization of a technically supported expertise, and the reification of disease, thus somehow losing sick individuals in the way, are but three faces of the same process in the origin of modern western medicine.
References 1
Beauvalet-Boutouyrie, S. (1999), Naître à l’hôpital au XIXe siècle, Paris: Belin. Birtalan, G. (1982), “Laennec and Skoda, Classics of Internal Diagnostics”, Communicationes de Historia Artis Medicinae (Budapest), nos. 97-99, pp. 33-41. 3 Bluhm, R. and K. Borgerson (2011), “Evidence-Based Medicine”, in: F. Gifford (ed.), Handbook of Philosophy of Science. Vol. 16. Philosophy of Medicine, Oxford: North Holland. 4 Bowker, G.C. and S.L. Star (1999), Sorting Things Out: Classification and its Consequences, Cambridge, MA: MIT Press. 5 Collins, H. and T. Pinch (2005), Dr Golem: How to Think about Medicine, Chicago: The University of Chicago Press. 6 Duffin, J. (1998), To See with a Better Eye: Life of R.T.H. Laennec, Princeton: Princeton University Press. 7 Fabian, J. (1994), “Ethnographic Objectivity Revisited: From Rigor to Vigor”, in: A. Megill (ed.), Rethinking Objectivity, Durham: Duke University Press. 8 Faulkner, A. (2009), Medical Technology into Healthcare and Society: A Sociology of Devices, Innovation and Governance, New York: Palgrave Macmillan. 9 Faure, O. (1994), Histoire sociale de la médecine (XVIIIe-XXe siècles), Paris: Anthropos.
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Foucault, M., Naissance de la clinique, Quadrige/PUF, Paris, 1963. English translation: The Birth of the Clinic, London: Routledge, 2003. 11 Hacking, I. (1983), Representing and Intervening, Cambridge: Cambridge University Press. 12 Illich, I. (1976), Medical Nemesis: The Expropiation of Health, New York: Pantheon. 13 Kervran, R. (1960), Laennec: His Life and Times, New York: Pergamon. 14 Kuhn, T.S. (1962/1970), The Structure of Scientific Revolutions, 2nd ed., Chicago University Press, Chicago, 1970. 15 Lachmund, J. (1999), “Making Sense of Sound: Auscultation and Lung Sound Codification in Nineteenth-Century French and German Medicine”, Science, Technology and Human Values, vol. 24/4, pp. 419-450. 16 Laennec, R.T.H. (1819), De l'auscultation médiate ou traité du diagnostique des poumons et du coeur, Paris: Brosson et Chaudé. 17 Laennec, R.T.H. (1821), A Treatise on the Diseases of the Chest, ed. by John Forbes, London: Underwood. English translation by J. Forbes. 18 Laín Entralgo, P. (1950), La historia clínica: historia y teoría del relato patográfico, Madrid: CSIC. 19 Laín Entralgo, P. (1978), Historia de la medicina, Barcelona: Masson. 20 Laudan, L. (1984), Science and Values, Berkeley: University of California Press. 21 Lindemann, M. (1999), Medicina y sociedad en la Europa moderna: 1500-1800, Madrid: Siglo XXI, 2001. 22 Longino, H.E. (2002), The Fate of Knowledge, Princeton: Princeton University Press. 23 López Piñero, J.M. (1985), Ciencia y enfermedad en el siglo XIX, Barcelona: Nexos. 24 Machan, T.R. (2004), Objectivity, Hants-Burlington: Ashgate. 25 Maulitz, R.C. (1987), Morbid Appearances: The Anatomy of Pathology in the Early Nineteenth Century, Cambridge: Cambridge University Press. 26 Megill, A. (1994), "Four Senses of Objectivity”, in: A. Megill (ed.), Rethinking Objectivity, Durham: Duke University Press. 27 Porter, T.M. (1994), “Objectivity as Standarization: The Rhetoric of Impersonality in Measurement, Statistics, and Cost-Benefit Analysis”, in: A. Megill (ed.), Rethinking Objectivity, Durham: Duke University Press. 28 Postman, N. (1992/1994), Tecnópolis, Barcelona: Círculo de Lectores/Galaxia Gutenberg. 29 Reiser, S.J. (1978), Medicine and the Reign of Technology, Cambridge: Cambridge University Press. 30 Shepherd, G.M. (2011), Neurogastronomy. How the Brain Creates Flavour and Why It Matters, Columbia Univ. Press.
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Shrader-Frechette, K. (1989), “Scientific Method and the Objectivity of Epistemic Value Judgements”, in: J.E. Fenstad et al. (ed.), Logic, Methodology and Philosophy of Science VIII, Elsevier. 32 Simon, J.R. (2011), “Medical Ontology”, in: F. Gifford (ed.), Handbook of Philosophy of Science. Vol. 16. Philosophy of Medicine, Oxford: North Holland. 33 Solomon, M. (2001), Social Empiricism, Cambridge, MA: MIT Press. 34 Stempsey, W.E. (1999), Disease and Diagnosis: Value-Dependent Realism, Dordrecht: Kluwer. 35 Thagard, P. (1999), How Scientists Explain Disease, Princeton: Princeton University Press.
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José A. López Cerezo, STS Research Group, Department of Philosophy, University of Oviedo, Spain. [email protected]
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What can neo-Aristotelian ideas contribute to establish an Integrative medicine? Konstantin S. Khroutski (Veliky Novgorod, Russia, Novgorod State University after Yaroslav-the-Wise)
Plan of the article 1
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Introduction. To reinstate the significance of Aristotle’s scientific Organicism ‘Kosmology’ vs ‘Spacelogy’ Developing the scientific legacy of Pitirim Sorokin and expanding the notion “supersystem” into the universalizing significance of the concept “cosmology” Aristotle’s Bio-physics and Organicist aetiology Aristotle’s essentialism vs Plato’s essentialism Comparative characteristics of the three main cosmologies (of Humanistics, Realistics, and Holistics) Fundamental Biocosmological principles of Bipolar Unity and Triadic Dynamic Cyclicity Triune essence of the modern all-embracing medicine aimed at the Individual’s1 health
1
Definitions ‘the Individual’ (the person) and the similar notion (in broader sense) ‘the Subject’ were developed in the previous work (Khroutski 2006), pointing out the universality of life on Earth. In Cosmist philosophy ‘subject’ means the integrated functionalist subject, which forever integrates autonomously and hierarchically other subjects (to be the functionalist whole) and, simultaneously, always being functionally integrated by the higher organised subject (organism). In other words, from the Cosmist point of view, subject means every living organism on Earth: molecule, cell, biological organism, bio-
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8.1 The main significance of the Medicine of Health 8.2 CosmoBiotypological medicine (CBM) 9 What can neo-Aristotelian ideas contribute to establish an Integrative Medicine? 10 Conclusion. Towards the rehabilitation of Aristotle’s scientific Organicism and creation of universalizing Triune medicine
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Introduction. To reinstate the significance of Aristotle’s scientific Organicism
During the recent conference in Seoul (2011), Prof. Patricia Churchland2 introduced in the beginning of her keynote speech a ‘cosmological’ (of comprehensive significance) position that there are two main traditions in science and philosophy that “really” exist and that lead to the modern “evidence” that “all mental states are really states of the brain’. The first is the tradition of Physicalism (exemplified in the lecture by the names of Hippocrates, Hobbes, and Hume); and the second is the tradition of Dualism (Plato, Descartes, Leibnitz). However, Hippocrates (who is recognized as the Father of Medicine; and whose methodological influence was really significant in the educational environment of Aristotle – the Father of Science) – Hippocrates and Aristotle are categorically not the physicalists or materialists (as Prof. Churchland and the modern scientific community consider them to be). On the contrary, both they are the evident Organicists who treated the world (cosmos) as the organic whole, but required to construct a research process on the basis of strict empirical facts (thus realizing the origination of modern scientific medicine and science in general). Thence, on the other hand, the foundation of modern medicine (modern science) is naturally realized on the principles of rational Organicism. Another important conclusion is that the evolutionary process of the growth of scientific knowledge (scientific organization and institutionalization) is not homogenous and monolinear. We evidently see that initially science was based on the Organicist principles, but, within the evolutionary time (some two sphere, human being, family, community, social body, society, mankind, and, ultimately, Evolutionary Process itself (EvoProcess, or Process, or CEPLE) – the one common whole cosmic evolutionary process of the life on Earth. 2 Professor of Philosophy at the University of California, San Diego. She is a leading expert in the field of neurophilosophy, former president of the Society for Philosophy and Psychology (SPP).
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What can neo-Aristotelian ideas contribute to establish an Integrative medicine?
thousands of years after) – it has transformed and referred scientific knowledge to the frameworks based on the opposite (to Organicism) Dualism and Physicalism. In the result, modern scholars (the scientific community on the whole) now takes for granted this (physicalist, anthropocentric) disposition as the only possible one and believes that scientific evolution always was homogenous and monolinear (and will follow this line eternally), i.e. – believe that from the very beginning (and forever) the scientific knowledge is (and ever be) of Dualist and Physicalist essence. However, in fact, this is a basically wrong disposition of monolinearity (accepted by the modern scientific community already on the global level). Indeed, the great physician Hippocrates attributed diseases to natural causes, formed a diagnostic system based on clinical observation and logical reasoning. But, on the other hand, Hippocrates substantially treated patients as psychosomatic entities (thus realizing a holistic medical approach). Therefore, due to Hippocrates, “as an art dealing with life, medicine was regarded as a part of philosophy in its broader sense.” (Marketos and Skiadas, 1999, p. 1162). Essentially, Hippocrates considered man as the organic part of the natural world and the subject to the same laws as the rest of the world. The first Western global and unitarian concept of biotypology – “humoral theory” of Hippocrates – precisely is based on this conception of man as a microcosmos that contains in itself all the characteristics of the universe.” (Marino 1999, p. 17). Therefore, in our modern terms, Hippocrates was a true naturalist, but he founded his scientific and practical activity exactly on the Organicist basis. In other words, he considered the natural world (cosmos) as the organic whole, and, thus, fully subscribed to a “whole humane (psychosociosomatic) approach to the patient.” (Marketos and Skiadas, 1999, p. 1163). In general, renowned objectivist (American philosopher) Ayn Rand had arrived at the valuable conclusion (1963): “If there is a philosophical Atlas who carries the whole of Western civilization on his shoulders, it is Aristotle. He has been opposed, misinterpreted, and – like an axiom – used by his enemies in the very act of denying him. Whatever intellectual progress men have achieved rests on his achievements (italics mine. – K.K.).” Indeed, Aristotle’s conceptual elements (parts, blocks) are used in every current philosophical and scientific theoretical edifice, but, exclusively, – as a Mean, and (still) not as the End (as the whole methodological construction). Eventually, in fact, we have lost the perception of Aristotle’s Organicist philosophy as the whole system of knowledge. Actually, our contemporary ur-
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gent task is to reinstate the significance of Hippocrates’ and Aristotle’s scientific Organicism.
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‘Kosmology’ vs ‘Spacelogy’
First of all, we are to answer to the question: How could it be that the foundations of medicine (and of modern science in general) are fundamentally different from the actually dominant (as of today) methodological principles of medicine and science? The answer is quite obvious – the developmental (evolutionary) processes of life (including the sphere of knowledge) are subject to non-linear – cyclic – dynamics. In other words, one the same life (as well as cognitive) effective process goes through cycles in which (each) the whole organization of life activity is explicitly (and substantially) different. For example, the daily biorhythm (at the physiological level) has three autonomous (independent from each other in terms of the whole organization) spheres of life: two polar – of Sleep aimless processes and purposeful Awake activity; and the intermediate (Integral) Organism (organ) itself that incorporates both (polar) mechanisms and carries our vital processes and homeostasis maintenance. Naturally, all three spheres take the dominant significance (by turns) during the whole biorhythm (each 24 hours of life activity). In general, the very idea of N-adic approach in respect to rational cognition is essential to be considered (that was recently coined by Leonardo Chiatti, in respect to the study of the interrelations between Pierce’s semiotics and quantum mechanics)3:
3
Herein, I refer to the site: http://www.researchgate.net/post/Do_elementary_particles_form_a_set_of_signs_in_the _spirit_of_CS_Peirce_semiotics
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What can neo-Aristotelian ideas contribute to establish an Integrative medicine? Table 1. N-adic approach to rational cognition Types / Criteria
Diadic (N=2)
Triadic (N=3)
Scientist (positivist) thinking
Dialogic, Dialectic, Integrative, Interdisciplinary approaches, etc.
The number of the poles of rational (reducible) knowledge
There are no poles, but the unified invariable “scientific” method is exercised
One pole, but ‘the other’ standpoints are taken into consideration
The advanced neo-Aristotelism (wherein Biocosmology is one of the spheres) Two equal poles – thus, bipolar perception of the reality is exercised
The possibility of alternative forms of knowledge
Impossible
Alternative forms of knowledge are admitted
Treatment of evolutionary processes
Linear model of evolution (both biological and cultural) is accepted – from primitive (infant) to complex (mature) forms
Evolutionary process is considered as the product of a Transcendent substance (like Matter, God, Information, Spirit, Energy, Field, etc.), allowing a cyclic character of the process but treating it as contemporarily the completed phenomenon
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Example the type
A-dic (N=1) of
Three autonomous (cosmological) spheres of knowledge (supersystems) are established as the equal supersystems; one of them, by turns, has the dominating significance Non-linear – Cyclic ascending (spiral), in the Past, Present and Future – evolutionary development (with alternating dominance of polar cycles) is the type
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“Kosmos is the Greek word for world,” as it is noted by Efstathia Valiantza (1996). In turn, Aristotle is a towering figure in the whole ancient Greek philosophy. Primarily, we are to acknowledge the obvious truth that Aristotelian cosmology is quite antipodal to modern astrophysics and perception of “cosmos” on the whole. The essential difference can be explained in the special comparative table, below.
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Table 2. Comparison of “Kosmology” and “Spacelogy” Kosmology (Bio-realism and AnthropoCosmism) Aristotle’s Bio-cosmos (Kosmos) which is finite, hierarchical, and qualitative – heterogeneous, is the Hierarchical Organicist whole that is chiefly driven by the goal-driven causes (c.finalis and c.formalis-entelecheia)
Spacelogy (physicalism and anthropocentrism) Physicalist and anthropocentric (dualist) cosmos (homogenous Space) that is infinite and which excludes goal-directed forces, at least, does not allow them into the scientific research
Aetiology includes and sets the equal importance of all four cosmic causes, but, among them – causa finalis and c.formalis-entelecheia have the leading significance
Physicalist aetiology excludes c.finalis, attaching the main significance to causa efficiens
Each subject is placed inside (within) the Organic whole (Kosmos); determining its/her/his existence (being) as the Functionalist activity
The position of a subject is determined outside (without) the surrounding physical world (space)
Therefore, an explorer follows a kind of “internal” (telic) epistemology
On the contrary, therein a kind of “external‘ (causal) epistemology is exercised
In 1930s Pitirim Sorokin presented to the world his theory of the “Social and Cultural Dynamics”, wherein he substantiated the Three-dimensional approach to the study of (sociocultural) reality. The Russian-American scholar disclosed the natural synchronous existence of the three (universal types of) autonomous
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spheres (in Sorokin’s term – “supersystems”) of a whole sociocultural organization: two polar – Sensate and Ideational spheres; and the third intermediate Integral supersystem. Each sphere (realm) has its own “ultimate premises” – the foundation for the all-embracing type (body) of the organization of all social and cultural systems in the given (macro)order. In 1961, in Salzburg (Austria), the ISCSC – International Society for the Comparative Study of Civilizations was founded. Pitirim Sorokin and Arnold Toynbee were among the founders (and, Sorokin became the First President of the ISCSC). The essential point of Sorokin’s theory is that every time all three spheres are synchronously active and equal in their significance, but, by turns (in cycles) – one of the supersystems takes the dominant significance. At present, we have the dominance of the “Sensate” (Western) sociocultural “supersystem”, but its dominance contemporarily is nearing completion. Thus, it naturally gives way to the domination of manifold forms of the Integral supersystem. In this, the gist is that each form of the Integral supersystem, and naturalist scholarly endeavour of this (Integralist) type (i.e. modern system, holistic, synthetic and integrative approaches) essentially bring together the basic principles and organizational patterns that belong to both the polar supersystems – Sensate (driven by extrinsic stimuli) and Ideational (driven by intrinsic stimuli).
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Developing the scientific legacy of Pitirim Sorokin and expanding the notion “supersystem” into the universalizing significance of the concept “cosmology”
Sorokin's scientific legacy is laid at the base of the Biocosmological association (BCA, originated in Veliky Novgorod, Russia, in 20104). BCA’s associates categorically do not treat “biocosmology” in the common sense of SETI (Search for Extra-Terrestrial Intelligence), which means investigation of the origin of life in the Universe. In general, Biocosmological approach in modern science and philosophy is based on Aristotle’s fundamental cosmological principles, such as: universal organicism; hylomorphism, aetiological unity of the four main cosmological causes, fundamental functionalism as the main methodological principle based on the inherent teleodriven essentialism, as well as Aristotle’s ethical eudemonism,
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The website of the BCA – http://en.biocosmology.ru/
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and likewise the proposed (Organicist) universal evolutionism and Noospheric relation to the global processes. In general, according to its original meaning, the notion “Cosmology” refers to the comprehensive (all-embracing) and autonomic (with its own intrinsic organization that is not controlled by extrinsic forces) sphere of scholarly endeavour. Otherwise, this is a supersystem that integrates all the constitutive (existing) systems (levels, approaches) of rational knowledge. Originally, the field of cosmological explorations deals with four main issues: a. A study of the Universe in its wholeness, i.e. fundamental rational representation about the world as a whole; b. A definite rational resolution of the aetiology – i.e. the issue of active (driving) causes in the cosmic whole; c. A definition of fundamental (universal) laws in respect of both physical (Non-Organic) and Organic phenomena and processes; d. Elucidation (in the accepted cosmological sphere) of the place and role of the individual in current evolutionary processes of the one cosmic universal evolution of life on Earth. According to the Triadic (Three-dimensional, Three-logic, Triune) approach, introduced to the contemporary science by Pitirim Sorokin, we have at least the three types of autonomic (independent from each other) systems of knowledge (cosmologies): two polar; and the third (or ‘the first’ in its significance) – intermediate (basic) – Integralist cosmology. Essentially, the notion “cosmology” (in the Biocosmological Triadic approach) precisely means the whole (all-embracing) realm of cognitive activity which encompasses the entire set of areas and divisions of knowledge; and which is similar to Pitirim Sorokin’s notion of sociocultural “supersystem”. In respect to the scientific pursuits endeavoured by the Biocosmological Association – the formula “Bio-3/4” was established during the first (organizational) Seminar, held in Veliky Novgorod (in July, 2010)5. In particular, “Bio” – points to “Organic”, or more exactly – to Aristotle’s “Organon”, which translation is “Tool” or “Function”. Likewise, “Bio” – means Bio-universality and that Biocosmology uses the universal Organicist relation to the world – the position “within” the one whole Organicist Cosmos. Herein, 5
More information is accessible in the BCA’s journal “Biocosmology – neo-Aristotelism” – http://en.biocosmology.ru/electronic-journal-biocosmology---neo-aristotelism
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What can neo-Aristotelian ideas contribute to establish an Integrative medicine?
scientific Organicism has the fundamental essence, thus urging the disclosure and use of the fundamental Organicist principles that are applicable (universal) in all the levels and processes of organization of life: biological, ecological, anthropological, sociocultural, global and Cosmist – of the individual’s ontogenesis and other evolutionary processes, including EvoProcess (these universal principles are discussed below). “4” – points to aetiological Four-causality, i.e., primarily – to Aristotle’s cornerstone principle of hylomorphism and the unity of all the four main cosmic causes (c.materialis, c.formalis, c.efficiens, and c.finalis), but, wherein, the intrinsic goal-driven causes (c.finalis and c.formalis-entelecheia) have the guiding role. “3” – means the universal cyclic Triadicity (and indispensible Bipolar Unity in the organization of each subject of life). Essentially, “3” – points to the universal principle of Triadicity (and cognitive Three-dimensionality, equally in scientific pursuits) – the permanently synchronous existence and dynamics of the Three universal life spheres: two polar; and the basic intermediate (Integral) one. This principle refers to all life forms and processes; in socioculturology, precisely Pitirim Sorokin disclosed and substantiated it (in his phenomenal “Social and Cultural Dynamics”, 1937–1941). All three spheres take the dominant role (in the whole organism or organ) by turn. Thus, as Sorokin stated, the Sensate supersystem is made up of: sensate science, sensate philosophy, sensate religion of a sort, sensate fine arts, sensate ethics, law, economics and politics, along with predominantly sensate types of persons and groups, ways of life and social institutions. Likewise, the Ideational and Integral supersystems consist respectively of Ideational and Integral types of all these systems6. It is important to note that Integral (intermediate) sphere has essentially the fundamental vital significance – of the basis that permanently self-maintains life processes and realizes the ontogenetic growth of Organism. Accordingly, the cognitive Triadic (Triune) approach, in general, deals with the three basic types of rationality – two polar: Physicalist-Humanistics and Organicist-Realistics; and the intermediate Integralist-Holistics types. It is important to note that the scale of Triadic cycles varies widely. While sociocultural cycles-eras go on in centuries, the other cycles – the ontogenesis (life) of the Individual – including her/his personal cycles (of the domination of each of the three spheres-supersystems) already take a decade. In the third area, 6
Citing from the site: “Pitirim A. Sorokin Collection at the University of Saskatchewan” – http://library2.usask.ca/sorokin/about/bio/philosophy
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for instance, the rhythm of myocardiocyte (cell of the heart) – realizing the polar cycles of systole and diastole – takes a second or less. Usually, the question arises: What is “neo-” in neo-Aristotelism? The first “neo-” realizes itself exactly in the appreciation (and realization) of this universal cyclic Triadic (Triune) approach wherein Biocosmological (the Aristotelian) methodology itself is just one of the three autonomic spheres of scholarly endeavours. The second “neo-” refers to the active use of the method of “essential metaphor” (Khroutski 2011). Using this method and applying an “essential” metaphorical example – we can immediately point firstly to the day-(24 hours)-biorhythm. The implication here is that we have each day two polar (opposite) supersystems (‘cosmologies’) – of Sleep processes and Awake-activity; and the intermediate basic Organism itself (the general “axis”), which adopts (into the growth process) all the results of development during the (aimless) Sleeping and purposeful Waking cycles (i.e. the cycles of domination of the polar supersystems); and which constantly self-maintains the “golden mean” – homeostatic norm (health) of the Organism (of all its organs and systems). The latter, essentially, is placed in-between two poles, and, naturally and basically – carries out the integral use of the actual mechanisms (patterns) equally from both poles. Likewise, in this light, integrating Sorokin’s achievements and principles of the Biocosmological approach, as well as including the physiological evidence (drawn from the use of the method of “essential metaphor”) – we can draw a comparison of the Biocosmological approach with the cyclic dynamic theory of Pitirim Sorokin (represented in the table below).
Table 3. Comparative analysis of Sorokin’s cyclic dynamic theory and Biocosmological conception In the theory of P.A. Sorokin (three main types of sociocultural supersystems)
In physiological metaphor
Sensate
Sleep aimless (chaotic, ruled by chance) processes of organic regeneration and growth
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In the Biocosmological approach
AntiCosmism (Humanistics)
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4
Integral
Fundamental well-being vitality and the foundation for Transition from one pole’s domination to the prevalence of another pole’s activity (Awakening, or the transition from Wakefulness to Sleep)
ACosmism (Holistics)
Ideational
Awake goal-driven (Cosmist, based on purposeful self-realizing) activity
RealCosmism (Realistics)
Aristotle’s Bio-physics and Organicist aetiology
Primarily, we are to recognize that Aristotle – Father of Science – is substantially the founder (Father) of Organicist aetiology and the scientific Organicism. The latter (scientific Organicism of universalizing essence) is essentially based on the Four-causal aetiology. The Greek word aitia means “cause” – the generative force that is the origin (or change) of something. Aristotle’s theory of the Four Causes is mainly expounded in his works Physics and De Anima (On the soul). Four-causal aetiology states the equal importance of all the four main cosmic causes: c.materialis, c.formalis, c.efficience and c.finalis. At the same time, the leading significance of telic causes (c.finalis and c.formalis-entelecheia) is the cornerstone moment of this aetiology. Herein, Aristotle’s “causa formalis” has exactly the essence of “formative cause” (as Peter Heusser states, 2011) – the active cause that “becomes a natural cause of physical explanations” (p. 161). Basically, Aristotle holds a teleological (inherently purposeful) worldview. Thus, inherent goal-driven (teleodriven) causes have the leading role and substantiate the fact that the subject’s potentiality exists for the sake of its/her/his Functionalist actuality. At any rate, we should remember the basic statement of Aristotle (made in his “Physics”, Book II, chapter 7):
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An important moment (‘centre of gyration’ of the whole system) is that Aristotle’s universalizing organicist aetiology is based on the cornerstone cosmological principle of hylomorphism. The latter notion reflects Aristotle’s theory which conceptualizes substance (of the natural thing) always as a compound of matter (Greek – hylo-) and form (Greek – morphe). Significantly, Aristotle was the first to distinguish between matter (hyle) and form (morphe). The principle of hylomorphism signifies that every natural body consists of two intrinsic principles, one potential, namely, primary matter, and one actual, namely, substantial form. Likewise, in this line of reasoning, one more special comparative table can be introduced. Therein, we conduct the comparative analysis of the three forms of science: modern physical sciences; modern biology (medicine); and advanced Bio-sciences (Aristotle’s Bio-physics).
Table 4. Comparison of modern physics, biomedicine, and Aristotle’s Bio-physics (Bio-sciences) Sciences / Criteria Subject of study
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Physical sciences
Non-organic phenomena and processes
Modern biology (medicine) Organic phenomena and processes, but excluding psychological and sociocultural (as well as co-evolutionary, Bio- and Noospheric) life forms and processes
Bio-sciences (Aristotle’s Bio-physics) Organic phenomena and processes at all levels: biological, ecological anthropological, sociocultural, global (Cosmist); evolutionary, Bio- and Noospheric
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The essence of fundamental notions and principles
Physicalist – which are originated from the study of the non-organic phenomena and processes, like gravity, or electromagnetism, or affinity, etc.
Basically are the same – physicalist. The main methodological principle is the physicalist (biological) reductionism. The main method of analysis and explanation is the modern mathematical logics
Organicist fundamental principles. The main method of cognition has the universalizing essence – by integration all the three main forms of knowledge: empirical, intuitive and logical-constructive
Basic belongingness (in origination)
Natural (belong to natural, i.e. cosmic forces)
Man-made (artificial, speculative), i.e. belong to a man’s reason and abstract analysis, but not to the real Nature (Cosmos)
Natural (belong to the Nature, i.e. Cosmist reality)
Number of theories
A few fundamental naturalist theories
Overwhelming amount of idealist (speculative) theories
Biocosmological approach that realizes a universalizing theoretical approach
Aristotle’s essentialism vs Plato’s essentialism
We should not lose sight of the existence of the current global crises (paradoxes). Firstly, this is the so-called ‘anthropological evolutionary paradox’, in relation to the individual: s/he is a uterine element of the one common whole cosmic evolutionary process of life on Earth (that is a natural sciences truth that is also confirmed at the genetic level); however, on the other hand, we deny the search for universal evolutionary knowledge and rely on the plural (different and often
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incompatible) sources of knowledge in defining human’s nature: biological, psychological, social, cultural, etc. The next is very obvious ‘global aetiological paradox’ which means that despite the huge success of modern (evidence based) medicine in the treatment (of acute) and management (of CNID-chronic non-infectious and CNTD-nontraumatic) diseases, modern biomedicine is unable to determine the aetiogenesis of chronic diseases (CNID and CNTD). Because of this modern medicine cannot develop a healing approach that enables complete recovery. Certainly, this is a human rights abuse. All this (and other crises and paradoxes) is apparently the result of the current ‘cosmological insufficiency’, that chiefly means the loss of Aristotle’s rational Organicism from our intellectual field of view. A key point is (as John Herman Randall Jr., renowned specialist in Aristotle asserts) – modern scholars “have come at Aristotle from the standpoint of the later medieval developments and problems” (Randall 1960, p. iv); and that the early modern scientists (including Bacon, Descartes, and Kant) had discarded Aristotle in rebellion against his religious interpreters. Randall also seriously doubts, “whether Aristotle can survive translation into the Latin substantives of the scholastic tradition, or whether it is possible to state his fundamental functionalism in the Latin tongue.” (Ibid.) The latter statement is in accord with the conclusion of Alexander Herzen, which was made in the 1845, about the “revolt against Aristotle” because of the “originality of the new thinking” and that “one must not forget that Aristotle of the Middle Ages was not the true Aristotle, but the one transcribed to Catholic morals, ... Descartes and Bacon, alike, denied him as the canonized pagan” (Herzen 1946). David Charles, in his “Aristotle on Meaning and Essence” (Clarendon Press, 2000) argues that Aristotle's actual account is distinct from the one often described and attacked as “the Aristotelian essentialism.” He states: “Aristotle’s account of essentialism is, I argue, distinct from that offered by its major competitors (whether conventionalists or Platonists, as these are characterized in Chapter 1), and is immune to some of criticisms developed by (for example) Descartes, Locke, and Quine. Aristotle is not, in my view, the type of Aristotelian essentialist they attack. Indeed, the form of essentialism he defends is preferable (in certain major respects) to the alternatives currently available.” (p. 3). Actually, the first priority is to find out the basic properties of the Aristotelian essentialism – in relation to Plato's cognitive pole. This comparative analysis is given in the table below: 166
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Table 5 Plato’s essentialism vs Aristotle’s essentialism Plato’s essentialism (PE)
Aristotle’s essentialism (AE)
PE basically has the idealistic (dualist) essence – it is centred over the primarily Idealist perception (of the ideas of Transcendent and Transcendental origin). Essentially, this is the representation of empirical resemblances (range of “resemblances”) of the perfect (‘ideal’) prototype of a thing under study – the subject-matter for mathematical analysis (logics). The latter forms the modern dominating physico-mathematical methodology of research that integrates physicalist approach (reductionism) and mathematical (abstract, based on Plato’s idealism and dualism) processing of the empirical data. This PE-type of cognition realizes basically the abstract-quantitative approaches to rational cognition, and uses the explanatory mode of scientific understanding of the real world, describing through mathematical analysis the extrinsic attributes of the physical world (answering on the question “How”).
AE has the opposite meaning and basically has the realistic (universalizing) – intrinsic and dynamic (cyclic) – essence centred over the substance of the given Individual (subject: thing, entity, human being) under study. The latter always conforms to the cornerstone principle of hylomorphism (stating that material and non-material causes of its/her/his existence and development are inseparable – always integrated into the one inseparable whole), but wherein the goal-driven causes have the leading significance (i.e. causa finalis and c.formalis-entelecheia). This Organicist (universalizing) approach is possible by means of the integration of all the three main modes of knowledge: empirical thorough research, intuitive substantial grasp, and the rational logical construction of the conceptual edifice. This AE-type of cognition realizes basically the Noospheric-qualitative approaches to rational cognition, and uses the definitive mode of scientific understanding of the real world, answering “Why” – by defining the substantial intrinsic goal-driven causes (of the Individual under study, which is empirically evident), which has the primary significance for the entire conceptual edifice.
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At the same time, a cornerstone moment is that all three spheres of life (and three spheres of knowledge) are equally essential and indispensable to life processes (to scholarly endeavours). For instance, we are to clearly understand that Platonic essentialism and physicalist reductionism (mainly in the form of modern physico-mathematical method) led to the emergence of a so-called ‘human causality’ – the human ability to “control over the lifeworld” (Saniotis and Henneberg, p. 11) and to change the world constructively, and thus – to realize an efficient progress in the humanitarian and socio-cultural spheres. Modern achievements in the development of democracy and social police in western and eastern societies, which release human creativity and realize colossal breakthroughs in scientific and technological progress – the fantastic advances in medicine, transportation, communications, information technology, etc. – is a clear confirmation. Finally, globalization has emerged as a new reality – essential intensification of worldwide sociocultural relations. All this is a direct consequence of the agency of ‘human causality’ (in turn, which substantially is based on the Platonic essentialism and physicalist reductionism). However, we should never forget that there is the other (Organicist) pole of life processes – i.e. of all the sociocultural domains, including institution of scholarly endeavour. This polar Organicist sphere of life processes (which is opposite to Plato’s pole) sets the position of an individual (the researcher) not without the current (of outward things) world, but who is placed within the self-developing Cosmist world. Herein (in contrast to Plato’s – aimless – essentialism) – an individual acts as the integrated (within) and essential unit (by virtue of its/her/his specific Functionalist potential and the self-realized activity). Essentially, the Individual’s Functionalist agency is as much the organ of the universal Evolutionary Process (all-embracing Organism), as the essential (Functionalist) tool of the ongoing evolutionary development (by contributing efficient functionalist results and products to the well-being of hierarchically higher – future – levels of the world evolutionary growth).
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Comparative characteristics of the three main cosmologies (of Humanistics, Realistics and Holistics)
Basing on the aforesaid, it is now possible to carry out an essential comparative (Triadic) analysis of the three main (universal) cosmologies. The results of this analysis are summarized in the table below7. Table 6 Comparative analysis of the three main cosmologies
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Cognizable spheres of life, under the influence of\ criteria The ultimate, true reality-value (metaphysics)
Humanistics (AntiCosmism) based on Plato’s essentialism
Holistics (ACosmism) Integralism
Realistics (RealCosmism) based on Aristotle’s essentialism
The human’s Transcendental (a priori) abilities (reason) that realizes survival (adaptation to) and development (construction of) the surrounding tangible world
The Absolute – Transcendent substance (God, Matter, Spirit, System, Information, Field, Energy, etc.) – which precedes and/or creates the real world, and which determines the harmonic order of the given (“in situ”) life phenomenon and the surroundings
The Universal (Organicist) Hierarchical Cosmos (Kosmos) wherein every life subject self-realizes its/her/his Individual’s constitution and inherent telic Cosmist Ontogenetic Functionality (COF)
7
A more detailed analysis is given in the article “Forming an evolutionary vector to the pole of scientific Organicism (Biocosmology)”, Khroutski 2013.
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Classical ‘physicalist’ physics
Systemic sciences and holistic investigations
Functionalist Organicist approaches
Aetiology
Three-valued aetiology that excludes the inherent teleodriven causes
Four-valued aetiology – with the equal significance of all the four Aristotle’s causes – they are equally treated within the given self-sustainable organic milieu
Four-valued aetiology – with the leading significance of inherent teleodriven causes (c.finalis and c.formalis-entelecheia)
Methodology
Based on the dualistic attitude and the use of physico-mathematical method; the latter excludes the reality of the teleodriven causes in the objects under study
Integralist (Holistic, Systemic), founded on the Transcendent basis; and which equally uses the principles, patterns, methods, data (and other means and approaches) from both poles (Physicalist and Organicist)
Based on the realistic (universalizing) fundamental functionalism – the integration of all three forms of cognition (empirical study, intuitive grasping and logical construction), and highlighting the leading role of inherent teleodriven causes
Anthropology
Man is treated as a bio-social creature – bio-organism, social actor and unique person who
Man is the microcosm who is integrated (in) and responsible (for) the development of
Man is the bio-socio-Cosmist individual and the essential functionalist (ontogenetic) agent of the Universal
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What can neo-Aristotelian ideas contribute to establish an Integrative medicine? withstands and successfully adapts to the environments, due to her/his consciousness
the predetermined harmonious world order, created by the Transcendent Absolute
The leading mechanism of exploration Scholarly ideology Reductionism
‘Explanatory’ – Anthropocentric
‘Understanding’ – Anthropoholist
Humanism and physicalism Physicalist and subjectivist
Physiological metaphor
Sleep (aimless and dualistic) processes
Integralism (Holism) Focused on the dynamic equilibrium of life processes under study Intermediate (Integral, Basal, Vital) life processes – of constant self-maintenance of the ‘homeostatic – normal’ equilibrium interval, and assimilation (embracing) the results of development during the polar ontogenetic cycles
Organicist world (Kosmos – Noosphere), and who has the equal nature of the macrocosm (to Biosphere, Society and the Cosmos on the whole) ‘Definitive’ – AnthropoCosmist Biocosmology (Organicism) Individual-Functionalist
Awake goal-driven activity (for a human being – mainly occupational; or specialized for the biological structure); and the (Functionalist) realization of the entire Individual’s ontogenesis (evolutionary growth, from infantile to mature forms)
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Above we argue the existence of the current ‘cosmological insufficiency’ and that each cosmology naturally contains the basic issue (item 3) – the definition and substantiation of “fundamental (universal) laws” in the given cosmology. The existing cosmological insufficiency likewise implies the modern loss (from the field of scientific research) of the true (full) aetiology originated and developed by Aristotle. Not surprisingly, the aetiology of modern medicine makes insufficient reference to Aristotle. Now, intentions of the human being are replaced by the significance of the causal outward precedents to a disease emergence. Modern medicine does not consider the “final cause” or “entelecheia” in biomedical research. In general, nowadays, natural Organicist principles (laws), although they are evident – are not allowed into academic areas. At the same time, along with the progress of modern scientific (i.e. modern conventional Western) medicine, including its main foundation of evidence based medicine (EBM), – we equally (and urgently) need an ‘evidence based philosophy and science’ (EBPS) for Bio-medicine as the all-embracing science. The time really is (for modern medicine) to elaborate its own Bio-theory (that is based on the own Organicist principles) and that could treat effectively all the issues of the Individual’s health.
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7
Fundamental Biocosmological principles of Bipolar Unity and Triadic Dynamic Cyclicity
At present, because the ‘cosmological insufficiency’ occurred (as it is argued), Aristotle’s rational Organicism is perceived (at best) from the standpoint of Medieval ontotheology, or the subsequent (anti-Aristotelian, in essence) physicalist dualism and anthropocentrism (humanism), which are unacceptable for the proper understanding and application of (neo)Aristotelism. Essentially, Aristotle’s physics and cosmology on the whole is autonomic (independent) from other cosmologies. Substantively, (neo)Aristotelism has its own fundamental physical (Organicist) laws, like universality and psychosomatic integrity of the organic world (which is the objective truth at least since the 1953, after the discovery of the structure of DNA by Watson and Crick); and the other fundamental realistic principles, like the cosmic origin of the organic world, or the dynamic cyclic essence of life processes. In the paper “All-Embracing (Triune) Medicine of the Individual’s Health” – 16 Organicist fundamental real172
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istic principles are proposed, which all evidently are proved by the objective data of modern sciences (Khroutski 2010). Among them, the principles of Bipolar Unity and Triadic Dynamic Cyclicity are essential for the development of all forms of medicine, including Integrative medicine. In this respect, two schemes are essential. The first shows that the well-known pyramid of Maslow during ontogeny (the life) of the Individual takes naturally the two polar meanings (reflecting, in Aristotle’s utterance, two modes of life: “live – to eat” and “eat – to live”). Herein, Maslow’s hierarchies take on two polar values, orientations and basic (ultimate) foundations, which reflect opposite directions of the general vectors of both (by turns) dominating poles and spheres of life. (Note: the abbreviation COF means the Biocosmological notion of “Cosmist Ontogenetic Functionality”8).
8
Due to the definition (Khroutski 2006), Cosmist Ontogenetic Functionality is “the health-design of every living subject (organism) on Earth, i.e. basic, inherent and distinct functionality. COF is the program of Cosmist functional essence, i.e. – the intrinsic hierarchical program of the subject’s (man’s) natural (healthy) successive and satisfactory transcending rise through all the macro-levels (biological and societal) of her or his ontogenesis, up to the Individual’s mature creative one – for the realization therein her/his Individual’s (functionalist) direct creative contribution to Evolutionary Process’s wellness. Thus, Cosmist Ontogenetic Functionality hierarchically organises the Individual’s entire repertory of biological and social needs in the one integral order. This order, in principle, repeats the hierarchy of the main stages of biological and social evolution on Earth. Hence, biological and social needs may be considered tools for COF to implement its self-unfolding and the ultimate self-actualisation. In other words, all biological and social needs of human beings conform to the ultimate end of her/his specific functionalist contribution to the wellness of the one common EvoProcess of life on Earth. The latter is mainly possible at the high creative level of mature social stability, the culminating point of the Individual’s ontogenesis.”
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Scheme 1. Two polar types of Maslow’s hierarchies of needs
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The other scheme strives to give the rational characteristics to the proposed two poles of life. This scheme expresses both poles (and the corresponding cosmologies) as hemispheres.
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What can neo-Aristotelian ideas contribute to establish an Integrative medicine? Awake (A-) pole of life organic processes is characterized by the inherent purposeful – goal-directed – life activity that is basically sensible, sane, reasonable – for the good of the ambient organism-world or the environment. Under this pole each subject of life realizes its/her/his purposeful – functionalist – integrity with the cosmist (organic, hierarchical) world. Herein, the subject’s life activity is essentially cosmos-centric and naturalist (realizing microcosm-macrocosm and macrocosm-macrocosm interrelations). On the contrary, Sleep (S-) pole (centre of life activity) is characterized by the essential sensory rupture (denervation) of a living subject with the world – for the realization of processes of assimilation, accumulation, restoration, regeneration, growth, development of one’s potentials – up to their readiness and ability to dominate in/over the environment, etc. For a conscious subject, substantially, the S-cycle of life activity is realized in the chaotic realm, governed by dominant dreams (per se – idealist ‘hallucinations’). Any life activity, during S-cycle, is essentially subject-centric (anthropocentric). Scheme 2. Bipolar essence of life processes
Following the same way, we can quite consistently propose the natural existence of the two poles of biomedical activity (reflected in the scheme below).
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H.–c .
Hom.–e.
P.–c .
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Scheme 3. Bipolar essence of the all-embracing medicine9
Applying the Triadic Biocosmological approach – we clearly see the reality of the two poles of Biomedicine: of Pathocentric medicine; and of Health-centric medicine. The latter directly deals with the subject-matter of the entire healthy ontogenesis (the entire life span) of the Individual. Health-centric medicine naturally has the first number (the leading significance). Due to the WHO definition, 194610, and in accordance with common sense – the task just of “the absence of disease” (and, implicitly, of the constant enlargement of her/his life adaptational potentials) cannot be the ultimate aim of a health care strategy. Indeed, in this direction, the sociocultural evolution on Earth would have long ago stopped.
9
Abbreviations in the scheme 3: P.-c. – Pathocentrism; H.-c. – Health-centrism; Hom.-e. – Homeostatic equilibrium (which is the central notion for the Medicine of Health). 10 “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
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Triune essence of the modern all-embracing medicine aimed at the Individual’s health
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In general, basing on the development of aforementioned (in the work) Organicist natural principles of Universality and the Cosmic origin of Earth’s organic world, as well as the principles of Bipolar Unity and Evolutionary Cyclic Triadicity (of all life processes, and in respect to their rational cognition) – we have therefore the right to propose the universal natural Triadicity (Triunity) of medical activity (theoretical and practical). In other words, we naturally have the three autonomous (equal and independent of each other) spheres of life and cognitive activity – two polar (opposite to each other in their organization); and the intermediate Integralist one which essentially uses the principles, mechanisms and patterns from both poles, but which equally (in the whole Triadic organization) is the autonomic, independent and essential sphere of life activity organization. All these spheres are equally essential for the realization of a successful human life throughout her/his ontogeny. We can represent these three areas in a schematic form and give the names to each sphere: to the polar – "Medicine of Diseases" and “Ontogenetic Medicine”; and to the intermediate (Integralist) sphere – “Medicine of Health”.
Scheme 5. Three spheres of Medicine
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Scheme 6. The Triune structure of contemporary medicine and its Bipolar hierarchical spheres
8.1 The main significance of the Medicine of Health Giving a brief definition to the Triune structure of contemporary biomedicine, we should highlight the central importance of the Medicine of Health (MoH) which is actually the Axial (Basal, Intermediate) sphere of life activity. In the Triune approach, Medicine of Health has the essence of an Integralist sphere, which main aim is to amplify and expand the organism’s ability to maintain the Homeostatic equilibrium (Golden mean, Health parameters) of all the vital life processes. Essentially, two medical directions are naturally realized in this sphere – of the “reactive” (Adaptational) and “proactive” (Recreational) medicine (Warren and Modell, 2006). The former follows the philosophy of prevention and aims at the preservation of health (and healthy abilities). The latter develops the philosophy of health promotion and aims at the maintenance of health (and development of healthy activities). Naturally, Medicine of Health (as the Ax-
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ial-Central sphere of the entire Triune edifice of contemporary medicine) has the basic significance. At present, still, Medicine of Health is chiefly based on the integration of modern conventional medicine (which currently has the essence of evidence-based medicine-EBM) and methods used in complementary and alternative medicine (i.e. integration of EBM-methods and CAM-methods). Likewise, the so-called Systemic medicine is active in this area. The latter reveals its theoretical foundations in systemic theory, “thermodynamic validation”, quantum physics, study of the “Human Energy Field”, etc.; and which relates itself to the field of “Evidence Based Complementary and Alternative Medicine” (Olalde Rangel, 2005). In the aspect of rationalism, however, all these forms (and the applied methods) still are reducible to the one cosmological pole – of the Dualist and Physicalist (i.e., anthropocentric – AntiCosmist) relation, perception and understanding of the world. On the contrary, from the Biocosmological standpoint, Health-centrism ultimately reflects the Individual’s functionalist (effective) contribution to the well-being of the whole life Process (Evolution) – whole Organism of the one global evolutionary process of life on Earth. Therefore, a great natural resource for the evolving of the Individual’s health (hence, of the capabilities of Medicine of Health, or Integrative medicine – its Integralist capacities) is the development and use of the resources of (so-called) Ontogenetic Medicine, firstly developing its domain and level of the CosmoBiotypological medicine.
8.2 CosmoBiotypological medicine (CBM) Substantially, CosmoBiotypological Medicine discloses, analyses and integrates (with respect to the Individual, and on the basis of Biocosmological approach) all the data in relation to her/his biotyping (constitutionology), thus universalizing the entire knowledge of all the three main spheres: biology (physiology), psychology, and socioculturology. To the point, anthropology is always a natural integration of rational knowledge in respect to the human being, for, the entire anthropological knowledge (referring to the Merriam-Webster dictionary) is “the study of human beings and their ancestors through time and space and in relation to physical character, environmental and social relations, and culture.” CosmoBiotypological
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approach (and CBM) do need the application of Organicist cosmology, expressed by the conceptual means of Aristotle’s philosophical system and its contemporary form of the Biocosmology. In this approach, the ultimate aim of the CosmoBiotypological medicine is naturally to assist the Individual’s self-actualization (i.e. self-realization of her/his COF – Cosmist Ontogenetic Functionality – within the given ecological-social-cultural milieu. Another grand task of the CosmoBiotypological medicine is the disclosure of the aetiogenesis of chronic diseases (CNID and CNTD). Yet in the ancient times, Hippocrates (the Father of Medicine) in his humoral theory substantiated the priority of internal causes for the appearance and persistence of chronic diseases. In the XX-th century, the internationally reputed Austrian scientist Bernhard Aschner corroborated that “the majority of all diseases does not come from without (like injury or infection), but from within ...” (Aschner 1941, p. 261). Indeed, regarding pathogeneses, we can distinguish three different types of diseases: a. Congenital and hereditary diseases, which comprise the essence of the congenital genetic damage or genetic defect. b. (1) Infectious diseases, which are caused by direct invasion of the external specific pathogen – “from without”; and (2) Traumatic diseases, which are likewise externally (“from without”) caused by the direct injury of the person’s body, during an acute or chronic period of time, by the specific – physical or chemical (toxicological) – factor or agent. c. Civilised man’s diseases (CNID and CNTD – chronic non-infectious and chronic non-traumatic diseases). Therein, still, aetiological factors are unknowable. In respect the ‘civilized man‘s diseases’ (CNID and CNTD), essentially, (patho)aetiology and pathogenesis is possible to be rationally disclosed exclusively in the sphere of scientific Organicism, which is capable to deal with internal and individualized (intrinsic) factors that cause the failures in the healthy balance of an organism and bring about the specific disease’s occurrence. In other words, chronic diseases (CNID and CNTD) have the internal causation (aetiogenesis), emerging “from within” and which are caused by the excess amount of the Individual’s creative (vital) energy that has not been applied and utilised by the Individual in carrying out her/his COF (Cosmist Ontogenetic Functionality) during the entire Functionalist ontogenesis (Khroutski 2002). In CBM-approach, subjective feelings of the Individual (her/his psychological world); her/his sociocultural behaviour and physiological biotype – all 180
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three main domains of knowledge are reducible to one the same meaning of her/his COF – the analogue of Aristotle’s ontogenetic entelecheia and energeia – thus naturally expressing of the one-whole Organicist knowledge of the Individual. In this (Organicist) approach, there is no separation of knowledge with reference to various levels of life activity (physiological, psychological, social, cultural, ecological, global, etc.). At the same time, naturally, Biocosmological (of the neo-Aristotelian essence) knowledge cannot be separated from the other two spheres (but always is naturally integrated with Integralist and Physicalist spheres of knowledge) – for the sake of the Individual’s well-being (the successful maintaining of her/his healthy – homeostatic – vital processes; and the effective treatment of diseases).
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9
What can neo-Aristotelian ideas contribute to establish an Integrative Medicine?
The definitions taken in the American NCCAM – National Center for Complementary and Alternative Medicine (of the National Institutes of Health, USA) are: “Complementary medicine is used together with conventional medicine”; “Alternative medicine is used in place of conventional medicine”; and “Integrative” medicine “combines treatments from conventional medicine and CAM for which there is evidence of safety and effectiveness.”11 The distinction of “Whole Medical Systems” (which have evolved apart from and earlier than the conventional medical approach) is valuable. Therein, homeopathic medicine, naturopathic medicine, “Traditional Chinese medicine” (TCM) and “Ayurveda” are included. From the Biocosmological standpoint, a reason is to distinguish the forms of ‘Alternative Medicine’ which exactly refer to the so-called “Whole Medical Systems”, i.e. which are based on their own philosophical and methodological foundations. A key point is that Hippocratic medicine (as it is argued above) is essentially the form of Alternative medicine (which is cosmologically distinct from the modern conventional medicine, although it is treated as its foundation).
11
Citing the NCCAM’s site: http://nccam.nih.gov/health/whatiscam
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Three basic features of Alternative medicine might be proposed: a. all forms of Alternative medicine categorically are founded on the Realistic (naturalist) relation to the world, i.e. are based on the observable laws of nature (or cosmos) and, thus, they are the originally developed – naturalist – systems of diagnostics and treatment, but not are based on man-made (abstract) principles which are the product of human mind (but not of Nature-Cosmos). b. in these (Alternative medicine’s) systems the man is basically treated as the inseparable part (microcosm) and the product of the Earth’s one common cosmic evolutionary life-process. Therefore, the general vector of Alternative medicine is turned to the pole of Aristotle’s essentialism and Organicist world outlook (thus confronting a dualistic-physicalist standpoint). c. in this holistic-organicist relation to the whole world-cosmos and treating an Individual as the microcosm, all forms of Alternative medicine essentially use the Bio-typological (constitutional) approach in considering the totality of the Individual’s symptoms and her/his personality traits, psychological state, sociocultural characteristics and physiological status – for the individualized holistic diagnosis and treatment. The gist, at the same time, is that any Integralist approach (like Yin and Yang theory) cannot have its own rational foundations in principle (for, it naturally contains in itself the polar meanings and mechanisms). In turn, essentially, in the case of adequate using the rational means from both (polar) spheres of knowledge – any Holistic (Eastern) teaching or conception can be contemporarily explained by the use of (relevant) rational elements (notions and conceptions – as constructional blocks – taken from the existing conceptual apparatus). Therefore, each Holistic system of knowledge (medical as well, for instance – TCM) can be naturally expressed (translated into) the rational form that is compatible with the modern conventional knowledge, and, thus – directly integrated into the whole world’s scientific realm. In this building a new rational approach to Integralist studies, Biocosmology is both the End (in the process of reinstatement the true significance of Aristotle’s scientific Organicism), and also a Means (tool – instrument). The latter serves to help scholars (who are active in the areas of system, holistic and interdisciplinary research) – to express rationally (using the accepted scientific language, but in the substantial Integralist forms) – their applied methods and the achieved results. This means, in the light of the Triune approach – precisely the universalization of medical knowledge. Especially, this approach could be
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useful for the contemporary global Holistic systems of knowledge, mainly of the Asian origination. In turn, without the use of Triadic (Triune) approach – i.e. in conditions of the unipolar mode of cognition – this task (of rationalizing – universalizing – the entire medical knowledge) becomes impossible. Therefore, we do need to return into scholarly endeavour the perception of Aristotle’s philosophy as the whole cosmological (Organicist) system, which all structures and sections are based on the fundamental general principles: • • • • •
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•
Organicist physics and metaphysics; Four-causal aetiology; Functionalist telic methodology; bio-socio-Cosmist anthropology; universalizing Bio-sciences (both natural, social, formal and human), which are ultimately directed at the Noospheric global sociocultural development and co-evolution.
In general, without the study of Aristotle’s pole of scientific Organicism, we are unable to realize the true rational construction of Integralist knowledge (including Integrative medicine), which has the intermediate position between (and integral relation to) the two poles of rational knowledge. For instance, Ming Wong – the author of the journal “Biocosmology – neo-Aristotelism” in his paper “The theory of Yin and Yang” in TCM and Biocosmology” introduces the cornerstone notion “Branch’s coupling”. It refers to his conception of “advanced non-equilibrium thermodynamics” (i.e. he attempts to introduce a basic rational notion into his Integralist construction, which is taken from the conceptual apparatus of the Physicalist pole of scholarly endeavour). From Ming Wong’s standpoint, a thermodynamics system is like the “Trunk”, and within this System there are many levels (“Branches”) of thermodynamic negentropy. With the input (inflow) of negative entropy, many interrelations (“couplings”) emerge between the levels (“Branches”), which realize dissipative effects; and which (couplings’) function is to organize and maintain the stability (existence) of the level, levels and the whole non-equilibrium system. “Branches coupling” has some similarity with the notion from the thermodynamics of phase change – “the crystallization point”, but it refers mainly to the study of life systems and their immanent (intrinsic) activity, and does not
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refer to non-life systems and extrinsic physicalist causality. In general, the “Branches couplings” vital function is the realization of the growth and evolution of the given advanced non-equilibrium thermodynamic system. For more details, author refers to the chapter “Branch’s Coupling” in his book “TCM and Metaphysics”. In all this, a general impression is that the use of the conceptual facilities from Aristotle’s (Biocosmological) pole of cognition (together with the already accepted notions and concepts from the Physicalist pole) could significantly contribute to the clarification of the author’s terminology and approach on the whole.
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10 Conclusion. Towards the rehabilitation of Aristotle’s scientific Organicism and creation of universalizing Triune medicine Referring to Pitirim Sorokin’s sociocultural cyclic theory, the statement is that we live currently in the realm of Sensual supersystem and the domination of its extrinsic stimuli, while intrinsic stimuli (which are characteristic for the Ideational supersystem, and which correspond to Organicist cosmology) are suppressed. In the result (due to the curriculum, education and the entire contemporary cultural milieu) – the prototypes of Organicist and cyclic (Triadic) thinking naturally turn to be difficult for understanding. In this connection, Russian scholar Yuri V. Yakovets has arrived at the following conclusion: “majority of social scientists hardly accept the proposed (by Pitirim Sorokin) division of sociocultural orders and the cyclical alternation of epochs that are characterized by the domination of this or that order, as well as Sorokin’s anticipation (prevision) of the main tendency towards the replacement of the sensate order (that was ruling for five centuries) by the integral order.” (Yakovets 1999, p. 12) Substantively, the first natural task is the rehabilitation and development of the true (universalizing) meaning of the pole of Aristotle’s Organicism (Biocosmology). In this case, when both poles of the rational knowledge will be rehabilitated and developed – a real perspective emerges to rationalize all forms of the Integralist sphere of science, firstly the areas of Integrative (complementary and alternative) medicine, thus rationalizing (and, hence, universalizing) the CAM-medicine’s basic conceptions of health and disease.
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In essence, this is a way to creation a truly all-embracing (Triune) medicine. Otherwise, if not to use a proper Triadic (Three-dimensional, Three-logic, Triune) approach – we will stay forever on the predisposition of the one-dimensional approach (the so-called “scientific method” based on strict empiricism and which excludes the goal-driven causality). Or, at best – we may count on the two-dimensional (of considering normal and alternative forms) approaches, in the modes of dialogue, dialectics, interdisciplinary research, etc. However, this route also does not bring us closer to the desired goal – achievement of the rational all-embracing (universalizing) knowledge in medicine. At any rate, we do need to carry out endeavours of rehabilitation Aristotle’s pole of scientific Organicism, thus approaching the level of the Three-dimensional cognitive activity and application of rational knowledge. In this way, firstly the area of medical agency (theoretical and practical) could be put on the agenda and become the initial point of destination, for, the subject-matter of the Individual’s health is the naturally universalizing direction of scientific pursuits. In other words, we substantiate the naturalist integration of all the existing rational knowledge (and creation of new approaches, if the needed knowledge is still lacking) – from all Three spheres: AntiCosmist (Physicalist), RealCosmist (Organicist), and ACosmist (Integralist). Therefore, drawing the conclusion – the challenge is to basically restore and rehabilitate the genuine Aristotelian scientific Organicism, cornerstone Four-causal aetiology, and to develop the proposed Biocosmological Triadic methodology. The latter can be evaluated as the key point of the whole approach, referring to the advancement and substantiation of the natural (real) existence of all the three autonomic (and synchronous) types of life organization and corresponding cognitive spheres: two polar; and the third intermediate – Integral(ist) one. In the Biocosmological approach they respectively are the autonomic (cosmological) spheres of AntiCosmism, RealCosmism, and ACosmism; which equally originate the corresponding three autonomic spheres of contemporary medicine (and the universalizing Triune medicine on the whole). Substantially, all three are organically united, for they are dynamically interrelated – realizing (by-turn) their dominance in the natural cyclic ontogenetic development of the organism (or growth of knowledge in relation to the Individual). Each cosmology (AntiCosmist, RealCosmist, and ACosmist) naturally has its own universal laws of organization (and this moment is pointed out above in the definition of cosmology, under the item 3). In this article, we shed light on the universal principles of Bipolar Unity and Triadic Dynamic Cyclicity. In the
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outcome, from the Biocosmological standpoint – we substantiate and characterize three realms of medicine: Medicine of Disease, Ontogenetic Medicine, and (the Integralist) Medicine of Health. The latter – Medicine of Health (Integrative medicine) – is the sphere of our topical interest. At present, it is chiefly represented by the actual forms of Complementary and Alternative medicine. The gist is that this area (of Integrative medicine) may (and ought to) become fully rationalized, and thus – to be compatible and become universalized (in the scientific relation) with the contemporary conventional medicine. However, for its realization – the primary need is to fully restore the pole (and the sphere as a whole) of Aristotle’s scientific Organicism. In turn, the first task in this way is the rehabilitation (in its fullest significance) of Aristotle’s aetiological theory.
References 1
Aristotle. (1968). De Anima Books II, III, tr. D. W. Hamlyn, Oxford: Clarendon Press. Aristotle. (1999). Physics. Trans. Robin Waterfield. Oxford, New York: Oxford University Press. 3 Aschner B. (1941). “Neo-Hippocratism in Everyday Practice.” Bulletin for the History of Medicine 10, pp. 260–271. 4 Charles D. (2000). Aristotle on Meaning and Essence. Clarendon Press, Oxford. 5 Churchland P.S. (2011). “Decisions, Responsibility and the Brain.” In: Proceedings of the 2nd International Conference on Comparative Studies of Mind – “How to understand human mind”. Institute of Chung-Ang Philosophical Studies, Korean Society of Mind Studies. Seoul, Korea. 2011. P. 5–25. 6 Heusser, P. (2011). “’Active information’ – a modern revival of Aristotle’s ‘formative cause’, applicable in physics, biology, psychology and medical anthropology,” Biocosmology- Neo-Aristotelism. Vol.1, No.2&3 (Spring/Summer 2011), pp. 161–167. 7 Khroutski, K.S. (2002). “Epistemology of civilised man’s diseases.” E-LOGOS: Electronic Journal for Philosophy / 2002. URL: http://nb.vse.cz/kfil/elogos/epistemology/khrout1-02.htm 8 Khroutski, K.S. (2004). “The Universalist Future of Contemporary Bio-Science” World Futures, 60(8), pp. 577–591. 9 Khroutski, K.S. (2006). “Personalist Cosmology as the Ultimate Ground for a Science of Individual Wellness.” Ultimate Reality and Meaning. Vol. 29(1–2), 2006, pp. 122–146.
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10
Khroutski, K.S. (2010). “All-Embracing (Triune) Medicine of the Individual’s Health: A Biocosmological Perspective.” Journal of Futures Studies, 14 (4), pp. 65–84. 11 Khroutski, K.S. (2011). “From the three-dimensional reality in the integral sociology of Pitirim A. Sorokin – to the construction of the triune universalizing (Bio)cosmological approach” Biocosmology – neo-Aristotelism, Vol. 1, No. 4 (Autumn 2011), pp. 369–395. URL: http://en.biocosmology.ru/electronic-journal-biocosmology---neo-aristotelism Khroutski, K.S. (2013). “Forming an Evolutionary Vector to the Aristotelian Pole of Scientific Organicism (Biocosmology).” Biocosmology – neo-Aristotelism, 3(1), pp. 28–52. URL: http://en.biocosmology.ru/electronic-journal-biocosmology---neo-aristotelism 12 Herzen A.I. (1946). Letters on the Study of Nature. Moscow, Gospolitizdat. (In Russian) 13 Olalde Rangel J.A. (2005). “The Systemic Theory of Living Systems and Relevance to CAM: Part I: The Theory.” Evidence-Based Complementary and Alternative Medicine. 2005 March; 2(1), pp. 13–18. 14 Marino, F. (1999). “Biotypology I: Scope and history.” British Homeopathic Journal. Vol. 88(1), pp. 17–19. 15 Marketos, S.G., and Skiadas, P.G. (1999). “The modern Hippocratic tradition. Some messages for contemporary medicine.” Spine. Vol. 24(11), pp. 1159–63. 16 Maslow, A.H. (1968). Toward a psychology of being. New York: Van Nostrand Reinhold Company. 17 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. 18 Rand A. (1963). “Review of J.H. Randall's Aristotle.” The Objectivist Newsletter. May 1963. 19 Randall J.H.Jr. (1960). Aristotle. New York, Columbia University Press. 20 Saniotis A. & Henneberg M. (2013). “Conceptual Challenges to Evolutionary Biology: A Necessary Step.” Biocosmology – neo-Aristotelism, 3(1) (Winter 2013), pp. 7–17. 21 Sorokin, P.A. (1985). Social and Cultural Dynamics: A Study of Change in Major Systems of Art, Truth, Ethics, Law, and Social Relationships. New Brunswick, New Jersey. Transaction Publishers, 1985 (Fourth printing 2010). 22 Valiantza E. Aristotle and the bio-environment / In. Biopolitics: the bio-environment; vol. V: Bioculture in the next millennium: International Sakharov Festival, Athens, July 28–31, 1994, ed. by Vlavianos-Arvanitis, Agni. Athens: Biopolitics International Organization, 1996. P. 527–529.
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Warren R.C., Modell, S. M. (2006). “Vital Dimensions: An Inquiry into the Ultimate Foundations of Optimal Health.” Ultimate Reality and Meaning 29 (1–2), pp. 78–97. 24 Wong M. (2012). “The theory of Yin and Yang in TCM and Biocosmology.” Biocosmology – neo-Aristotelism, Vol. 2, No. 4 (Autumn 2011), pp. 326–339. URL: http://en.biocosmology.ru/electronic-journal-biocosmology---neo-aristotelism 25 Yakovets, Yuri V. (1999). “The great insights of Pitirim Sorokin.” Sociological Studies 6, pp. 3–12 (in Russian).
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Anthroposophic medicine (AM) A short introduction into basic concepts Gerhard Klünger (University of Vienna)
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Topics 1 2 3 4 5 6
Position of AM in relation to academic medicine Methods of cure Quality assurance and picture forming methods Methods to gain knowledge Organization Critics and discussion
1
Position of AM in relation to academic medicine
AM as extension of academic medicine AM claims to be an extension of academic (western) medicine, extending practical medicine. It was not intended to be an alternative to modern medicine. It is difficult to decide if this was a pure political step to avoid an enmity of academic medicine from the very beginning. Though Rudolf Steiner (1861 – 1925)1, who founded AM, stressed the fact, that all findings of academic medicine are accepted as long as they are true, a closer look to his concepts show big differences and even contradictions to academic medicine.
1
Further information about Rudolf Steiner can be found in his autobiography GA 28 and at http://en.wikipedia.org/wiki/Rudolf_Steiner
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His lectures on AM started already 1920. These lectures were published later from short-hand notes of scholars without being reviewed by Steiner and may bear mistakes in the way Steiner didn’t say or did not intend to say. The first and only book about AM reviewed by Steiner is GA 27, published 1925 together with Ita Wegman2. Books with focus on AM are GA 27, 312, 313, 314, 315, 316, 317, 318, 319, 327, and 348.
Practical medicine as an art What is of some importance is the fact that Steiner considers medicine not only as a science, but equally as an art. This should not be confused with artistic therapy, like curative painting, modelling, eurythmy, and so on. The way the physician treats the patient is somehow “artistic”, as it is a creative work in so far as the specific treatment for a specific patient has to be invented to some extent by the physician, taking into account also his own capabilities and abilities. Therefore it can be that different physicians propose different treatments for the same patient and the same illness.
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2
Methods of cure
AM uses a variety of methods to treat patients, as medication, dietetics, nutrition, rhythmic massage, color therapy, curative painting, therapeutic modeling, music therapy, curative eurythmy, and curative speech formation.
2
GA 27 Rudolf Steiner / Ita Wegman: Grundlegendes für eine Erweiterung der Heilkunst nach geisteswissenschaftlichen Erkenntnissen. (1925). “GA” refers to “Gesamtausgabe”, the collection of all publications of Rudolf Steiner.
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Anthroposophic medicine (AM) - A short introduction into basic concepts
1. Bushes of Mistletoe on trees
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Medication First of all should be mentioned the genuine preparations based on distinct formulations given by Rudolf Steiner. Examples are “Iscador®” made from mistletoes, a medicament against cancer, “Infludo®” in case of influence or “Gencydo®” for patients suffering from hay fever.3 Homeopathy is a part of AM. AM therefore shares all the problems homeopathy is confronted with. Phytotherapy, medical herbs, minerals and medicinal springs are used. Parts of folk medicine, when found useful, are integrated.
3
For a detailed list see the publications of Weleda.
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Weleda-AG (incorporated company) The company was founded during the lifetime of Steiner and was headed by Ita Wegman for producing the specific medicaments that were needed in AM. Figures of 2012 name branch offices in more than 50 countries (also in China, Hong Kong, Japan, Malaysia, South Korea, Taiwan and India) with more than 1900 employees, producing and distributing about 1400 anthroposophic pharmaceutical products, dietetics, and about 100 cosmetic products. 260 different medical plants are “biodynamically” cultivated (according to lectures given by Steiner in GA 327) on an own, 200.000 m² area, which is the biggest garden for medical plants in Europe.4 Cosmetic products have a high reputation at consumer organizations especially because there are no herbicides or insecticides used to cultivate the herbs, and no other chemicals, dyes or preservative agents are mixed in the products. In the meantime there are also other companies like “Wala”5 specialized on the production of anthroposophic medicaments. Smaller companies focused on the production of mistletoe-based remedies for cancer, e.g. Helixor® or Isorel®.
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Dietetics, nutrition Steiner gave a big review on effects of different foodstuffs on organs and mind and mentioned explicitly the importance of dietary measures in certain cases (e. g. GA 319, p. 102, GA 348, p. 33). Rita Leroi, former head of the production of “Iscador®”, compiled a lot of those indications and statements scattered throughout the lectures of Steiner (Leroi, 1953).
Rhythmic massage A classic massage enhanced with anthroposophic concepts, developed by Ita Wegman and her scholar Margarethe Hauschka (Hauschka, 1978).
4 5
Weleda, see http://de.wikipedia.org/wiki/Weleda_(Unternehmen) Wala, see http://de.wikipedia.org/wiki/Wala_Heilmittel
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Anthroposophic medicine (AM) - A short introduction into basic concepts
Special elements of this technique are flowing, rhythmic movements and special forms like lemniscates and phase-delayed movements.6 In figure 2 different movements for a calming and an activating heart massage are given.7
2. Rhythmic heart massage
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Color therapy Based on GA 291, p. 145ff and others, chromotherapy (also called color therapy, colorology or chromatherapy) will be applied in certain cases. Trained chromotherapists claim to be able to use light in the form of color to balance unbalanced “energy”, whether it is on physical, emotional, spiritual, or mental levels.8
Anthroposophic art therapies Art therapy is a kind of therapy using art for curative purposes. The main areas are painting, modeling, music, eurythmy and speech formation. The last two are genuine anthroposophic, the others underwent a specific anthroposophic influence. 6
Rhythmische Massage, see http://de.wikipedia.org/wiki/Rhythmische_Massage For details see Hauschka, 1978, p. 154. 8 Chromotherapy, see http://en.wikipedia.org/wiki/Chromotherapy 7
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Apart from specific effects all kind of art therapies should help to harmonize emotional life. Since every illness has as cause or at least as accompanying effects emotional aspects, treatment of the soul of patients is as important as treatment of their bodies. Furthermore, the division between body, soul and spirit is considered as an artificial one, established only for scientific reasons to make human organization better understandable. In reality all those constructs are involved in and interacting with each other in an intense way, as is nowadays confirmed from psychosomatic and somatopsychic medical schools. Curative painting
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Steiner who not only painted the ceiling of the first Goetheanum, also held lectures on the nature of colors, e. g. GA 291. To use this knowledge for curative purposes was only a small step. There are mainly two different techniques, “wet-in-wet” and “layers”. The techniques are also used for educational purposes in Waldorf-schools.
3. Wet in wet technique: “blue”
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Anthroposophic medicine (AM) - A short introduction into basic concepts
Common for both techniques is the so called “therapeutic stroke of the brush”: the brush should be moved in a silent, smooth, gliding way, rhythmic and in harmony with breath. At the beginning of the stroke it should softly touch the paper just with an edge, to the middle of the movement fully touch the paper and again to the end of the stroke softly retract from the surface. The paints are supplied in a set of red, yellow, and blue in two hues: carmine and cinnabar, lemon and golden yellow, Prussian blue and ultramarine. The paints should be applied in a way that an impression is preserved as if light is shining from behind the colors, out of the paper, which can be established only if paints are not applied too thickly. When using more than one color then care should be taken that only those colors come in touch that are neighbored in a rainbow; therefore no brown nuances should occur. Violet, indigo and purple have special meanings since they could only be seen if the prismatic colors (rainbow colors) are bent round to a circle so that the red end meets the blue end (circle of colors). Since there is no “white” as an applicable color, subjects have to concentrate to omit areas where they think white should appear in the picture. The paints (colors) are generally produced from plants. Apart from being “natural” they are considered to be more “vivid” compared with synthetic colors, but are not as shining and lasting. The emphasis of the wet-in-wet technique is laid on avoidance of edges, lines, technical objects, drawings. The subject should concentrate on the color itself, accompany it with emotion and feelings and not draw objects. Avoiding sharp edges means just the opposite to normal world, where everything has sharp contours, also opinions and feelings. In contrast, very smooth transitions from one color to the next, from one tone to the other should be produced softening and reviving hardened emotions and feelings. World is not black and white. From the beginning the paper is sucked with water which helps to prevent sharp lines. Further points to be observed are that colors get deeper (“heavier”) on the lower edge of the paper and “light” on the upper edge. Beginners start with only one color. In an advanced step the layer-technique can be used. Here the paper is dry and the subject has to wait after each layer that has been applied until the paint is dry enough that the next layer can be applied without blurring into each other. The soft transitions have to be consciously produced with a lot of similar layers laid upon each other.
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4. Layer-technique: “Circle of colors”
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As colors dry pictures soon lose their shining. It is difficult to use this pictures for decorative purposes since light also destroys the colors in time. All this is no problem since no value is laid on the finished picture but all on the process of painting. Nevertheless, since many patients ask for their work to take it home it usually will be handed over to them.9
Therapeutic modeling Again in therapeutic modeling, no importance is laid on a “beautiful” result in the sense of “art”, but on the process of handling the tasks. It is also used for educational purpose in Waldorf- (Steiner-) schools. Wax or, for adults clay is the preferred material. The subject is supplied with a quantity of clay that can comfortably be held between two hands. Basic exercises are to start with a ball and then transform this ball, step by step, to platonic bodies: tetrahedron, hexahedron (cube), octahedron, dodecahedron, and icosahedron.10 9
Further information can be found at http://www.wegmanklinik.ch/de-de/therapie/kunsttherapie/therapeutischesmalen.aspx 10 Platonic bodies in Wikipedia, see http://de.wikipedia.org/wiki/Platonischer_K%C3%B6rper
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Important is the technique the subject should use: The surfaces of the ball and the platonic bodies should be formed only by pressure of thumb under control of eye and by no mechanical means; e. g. the clay should not be pressed against the table or any other surface to produce a plane. Same is true for the edges between planes: they should not be pressed out of the clay with two fingers or other tricks but appear without further action as the planes of the platonic body are formed to perfection. A lot of concentration and imaginative power is necessary to transform the bodies into each other without a transition through the state of a ball or some chaotic situation. A sample of platonic bodies is shown to the subject, so he or she need not know them by heart. The teacher or therapist then explains the relation of planes, edges and corners of one body to the next one. For example, as a tetrahedron has six edges and a cube has six planes, the edges of the tetrahedron have to be transformed into the planes of the cube. It helps to imagine the tetrahedron being located inside the cube in a way that all its edges touch as diagonals the planes of the cube. The process of transformation of one body into another under full control of the basic concept of transformation without losing symmetry and regularity may take hours or days. There is no contest who is finishing the task the fastest. However, not only platonic bodies might be modeled, but also small vessels, animals or human forms. 11 In Lukas Klink, a hospital in Swiss specialized for cancer treatment12, curative painting and modeling was regularly suggested to patients on a voluntary basis. If patients are compliant they will be brought from a hasty, stressed attitude to calm down to patience and concentration.
Music therapy First known concepts of music therapy are already mentioned in the Bible. Greek playwrights were aware of different effects of different keys onto the emotions of the audience. Even today classic music is often announced with key (and the speed of the movements) though since Johann Sebastian Bach instru11
Further information can be found at http://www.wegmanklinik.ch/de-de/therapie/kunsttherapie/therapeutischesplastizieren.a spx 12 Lukas-Klink, http://www.lukasklinik.ch/start/
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ments are usually “well-tempered” and the specific character of the keys is widely lost. Arabian physicians applied from the 9th century music for the treatment of mental sick.13 Based on GA 283 and others, scholars of Steiner developed supportive therapeutic techniques, also using sounds of different instruments, including pentatonic scales. Music instruments for children developed on anthroposophic concepts, as for example xylophones, use pentatonic keys14. Studies to become an anthroposophic art therapist are offered at different locations.15
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Curative eurythmy Eurythmy16 is a genuine invention of Steiner. A series of lectures were compiled in GA 277, 277a, 278 and 279. It is an art of moving mainly accompanying speech or music, but should not be confused with gymnastics or ballet. As the title of GA 277 already suggests, the movements made with arms and the whole body should be a “natural” expression of the soul as Steiner transformed psychic to physic movements.17 Eurythmic lessons are also part of Waldorf education and don’t replace sports. Sports, gymnastics prepare children to get fit for world; eurythmy wants to express what is inside the human, his inner feelings (GA 311, p. 112). Since language also origins in expression of feelings, alphabetic characters can be related to eurythmic movements and eurythmy becomes a “visible speech”. The
13
Music therapy, see http://de.wikipedia.org/wiki/Musiktherapie http://en.wikipedia.org/wiki/Music_therapy 14 Musikinstrumente, see http://www.ursprung-handelsverbund.de/Musikinstrumente.html 15 For example ”Studiengang Anthroposophische Musiktherapie” in Berlin, Germany http://www.bildung-anthromed.de/index.php/kunsttherapie/ausbildung/41-studiengang-anthroposophische-musiktherapie-berlin (2014-03-08) 16 Though the term “eurythmy” is deriving from the Greek “eu” (beautiful) and “rhythm”, “eurythmy” is written without an “h” between “r” and “y”. 17 Search in www.youtube.com with search term “eurythmy” for examples to get an impression. An example for curative eurythmic exercises in the case of aphasia can be found at http://www.youtube.com/watch?v=KowTQKY7IMI (2013-08-26).
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same is valid in respect to music, and eurythmy can be considered as “visible music” (GA 277a, p. 11). In curative eurythmy emphasize is laid on harmonizing body and soul, finding one’s balance and orientation in time and space, experience also one’s limits, improve coordination of arms and legs, adopt to spoken rhythms and so on.18 Since 2005 costs for curative eurythmy can (but need not) be refunded by health insurance funds in Germany.19
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Curative Speech Formation Speech formation (“speech is formed expiration”) originated primarily as training for speakers who promoted ideas of social threefolding20; later teachers and actors on stage (theatre plays and recitation) also adopted the method.21 Apart from training the voice for strong demands or to cure voices damaged by overstress, emphasize is laid on clear pronunciation of vowels and consonants, correct sound formation together with rhythm of text and in rhythm with breathing. Steiner explained the evolution of spoken language with its vowels and consonants as expression of feelings subjects had in old times when being confronted with different objects: consonants representing rather the objective view of the object, vowels expressing the inner feelings. Artists, poets, will unconsciously choose words with many vowels if they try to express mainly feelings (GA 281, p. 100ff). Curative Speech Formation is offered for a wide area of illnesses and problems.22
18
A long list of indications can be found “Verband diplomierter Heileurythmisten in Österreich” at http://www.heileurythmie.at/116.html (2013-12-09) 19 Eurythmie, http://anthrowiki.at/Eurythmie (2013-08-26), http://de.wikipedia.org/wiki/Heileurythmie#Heileurythmie (2013-12-05) 20 Social threefolding, see https://en.wikipedia.org/wiki/Social_threefolding (2013-12-09) 21 Sprachgestaltung, see http://anthrowiki.at/Sprachgestaltung (2013-12-05) 22 For a list where curative speech formation is indicated see “Therapeutische Sprachgestaltung des Schweizer Verbands für Anthroposophische Kunsttherapie, http://www.therapeutische-sprachgestaltung.de/therapie-indikationsliste/ (2013-12-05)
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3
Quality assurance and picture forming methods
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There was a strong demand to make things “visible” that under ordinary conditions are invisible, especially for the very fine “forces” or “powers” Steiner spoke about. As long as “quality” cannot be observed directly, auxiliary means are necessary for quality control and quality assurance of medicaments or biodynamically grown herbs and nutrition. In western science there is a strong tendency to reduce quality to quantity. In contrast, for diagnostic purposes to get a more “holistic” picture, new methods were required in addition to traditional chemical analysis. Mainly three techniques were invented: Copper chloride biocrystallization, capillary dynamolysis, and flow contour analysis.23 They support the Goetheanistic approach: training the mind to get directly hold of what is “quality”, to experience “essence”.
5. Copper chloride biocrystallization, control sample
6. Fresh Brussels Sprouts
aged Brussels Sprouts
23
The original German names are “Bildschaffende Methoden” (not to be confused with “medical imaging”, X-ray or X-ray computed tomography). Sensible Kristallisation, Steigbild and Tropfbild (or “Tropfenbild”) are the respective terms.
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Copper chloride biocrystallization The method was invented 1925 by Ehrenfried Pfeiffer, a German chemist. Into a solution of CuCl2 small amounts of the sample are mixed. As the water evaporates, CuCl2 crystallizes, building different structures. Depending on the sample, the crystallization appears differently and is subject to interpretation. The method is documented in accordance to ISO 1702524.
Capillary-dynamolysis
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The method was invented by Lili Kolisko and the chemist Rudolf Hauschka. The first steps are close to early techniques of paper-chromatography. In contrast to the latter, the main purpose is not the separation of the components of a sample and then measuring the relative retentions in relation to the front of the solvent. The whole process is run in a way that there is no clean separation of the compounds of the sample, but as the solvent on its way through the filter paper solves more or less of the sample, figures, forms and shapes with various colors are formed and are the source for interpretation.25
7. Capillary-dynamolysis (“Steigbild”)
24 25
See http://de.wikipedia.org/wiki/Kupferchloridkristallisation (2013-12-09) Kapillar-Dynamolyse, see http://de.wikipedia.org/wiki/Steigbildmethode (2013-12-08)
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Figure 8 shows the sequence of 30 pics produced on subsequent days throughout June 1976 from the sap of daily harvested mistletoes viscum album mali (mistletoe, grown on apple tree). Care was taken to harvest in a reproducible way (same region of the same bush, same time of day). The practical meaning of such investigations was to find indications on the best date to harvest mistletoes for the production of Iscador®.
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8. Sequence of 30 pics from daily harvested mistletoes
Flow Contour Analysis The method was developed by Theodor Schwenk 1967. In a flat round dish filled with some ml of a 15% glycerol-water solution, drops of clear water fall from a capillary (black line from the right to the center) into the center of the dish. A special technique of photography shows differences in optical densities within the liquid (“Schlieren”). Forms and shapes vary depending on the samples added at the beginning to the glycerol-water-mixture.26
26
Flow Contour Analysis, see http://de.wikipedia.org/wiki/Tropfbildmethode (2013-12-08)
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9: Flow Contour Analysis; Spring water
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4
Processed tap water
Water contaminated with detergent
Methods to gain knowledge
A fundamental feature of anthroposophy in general and of AM in particular is the outlined way on how to gain own knowledge. Anthroposophy was never meant as a belief system. A legal license to practice medicine is a precondition for anthroposophic physicians. Studies of AM are an additional training but should be started already during the regular study of medicine, comparing the official teachings with that what AM has to say about the same issue. Studying AM means in general the same as studying any other subject: first the student has to learn what was found by seniors, but the student is requested not just to learn it by heart, but to crosscheck it with his own experience and thinking. In the case that his own observations are insufficient in a specific area, thinking about the way how others made those observations and considering their arguments should help him to develop trust.
Goetheanism Studying AM means exercising and practicing at the same time because the student has to acquire not only theoretical skills. Since AM is a holistic approach toward humans, the student should adopt the Goetheanistic method. Some features of this method are:
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The human itself is the best instrument (GA 1, p. 334f). A trained physician of AM should not only evaluate laboratory values but also relay on his intuition and trained organs of perception. Qualities instead of quantities: modern medicine reduces health or illness to parameters that can be measured. This reductionist approach cannot understand human illnesses as a complex process, involving body, soul and spirit on the way towards a new equilibrium. Never transgress the limits of experience! In contrast to pure empiricism thinking is considered as an organ of perception for ideas. Scientific work means what is called “anschauende Urteilskraft” that is, coming to an understanding of the nature of an object by opening senses and opening thinking as the organ of perception for ideas. A Goetheanistic scientist doesn’t build models or apply theories to the object of observation, but let tell the object itself what its nature is. Goethe (and Steiner) considers the nature of an object as an “idea” and a deepened thinking as being able to perceive this idea in the form of concepts. In contrast to academic practice, that is first to adopt a theory and then investigation and interpretation has to be guided by this theory, the Goetheanistic approach is open-minded and avoids to recognize only that fits to a presupposed theory or model. Metamorphosis plays an important role (GA 1, p. 14). To get a feeling about what is the driving force in nature behind physical appearance Goetheanistic studies of plants are encouraged. The sequence of leaves, starting with the seed and proceeding through all organs of the plant to the new seed in all their differentiations can be understood as metamorphosis of the one underlying idea of this plant as a leaf, brought to appearance along a timeline. Never all different organs of a plant appear at the same moment. Furthermore, an infinite series of intermediate forms between two leaves are possible, but only view of them will find their physical (visible) expression. In general we consider as plant what can be touched with hands, seen with eyes. Goetheanistic consideration shows that what is visible at a time is not the whole plant; it is just a moment of physical expression of something that is mainly invisible. The Goetheanistic approach guides the attention to the invisible idea governing the physical appearance. (Also for AM this is important; otherwise the physician is in danger to stick to the visible symptoms instead of concentrating on the invisible idea governing the physical appearance. According to Goethe, ideas are invisible for eyes, but visible for the developed mind.)
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Figure 10 shows the sequence of leaves of the main stem of Papaver rhoeas L., rearranged in a loop: starting with the first leaf of the seed on the lower left until the last leaf on the lower right when the next seeds are built.
10. Sequence of leaves of Papaver rhoeas L.
How to acquire own knowledge and insight Several books cover the methods on how to develop what is called “higher experience” (GA 9, 10, 12, 13, to name only a few). Importance is laid on the fact that the practitioner has to understand what he or she is going to practice and why a specific exercise helps to develop a specific ability. There are no mysterious instructions beyond reasonable comprehension that have to be obeyed to gain “enlightenment”. There is no master or “guru” one has to devote oneself, nothing is prescribed as a duty someone has to obey to. Everything is laid into one’s own will and own decision. The books should be taken as a personal instruction given by someone who has already some experience and is now telling to the interested reader how she or he can also proceed
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on the way (GA 10, p. 222). The situation has some similarity with a report on foreign countries that someone has already visited for many times, and telling the best ways to come there. Neither one needs to travel there nor has one to take the proposed ways. It is up to everyone’s own judgment if he finds it interesting enough to visit himself those places and find the reasoned descriptions of the proposed ways convincing enough to follow them. Mainly all exercises strengthen will, concentration and the sensitivity for those feelings that usually pass by or don’t come to full awareness. Focus is laid on broadening the consciousness by mental practices. Many of those exercises might be considered as a type of “mental hygiene” which can be done for personal development to cope with daily life without targeting to “higher experience”. Rare exercises are mentioned that deal with the body, but they play only a marginal role. Five minutes a day are theoretically sufficient – if you practice the right way (GA 10, p. 31), so nobody is excluded from personal development because he or she lacks time. In contrary, it would be against the non-elitist principle that everybody can develop, if this training would prevent someone to fulfil his daily duties. It should be mentioned that no “higher” experience can be enforced by practicing (GA 9, p. 205f), but without exercising the probability to gain some higher insight diminishes. The situation has some similarity with farming: even if a farmer sows and cares his field, there is no guaranty he will have a harvest. There can be seen some contradiction to Steiner’s statement, that everybody can gain higher knowledge (if he proceeds the right way) (GA 10, p. 41). Critics locate here an immunization against a general failure of the method: whenever someone reports no success in his efforts, he has to face the argument, that he didn’t do it right and / or nothing can be enforced.
Epistemology Rudolf Steiner considers Goethe’s and his own epistemology as basis of all knowledge (GA 1, 165-167). In a series of early publications he covers the problem what is knowledge and in addition how knowledge is possible (GA 1, 2, 3, 4, 6, e. g.). In contrast to contemporary epistemology, heavily influenced by Immanuel Kant’s “thing in itself ”, Steiner shows that such an epistemology starts not really without presuppositions when it is constructing “things in it206
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self ” or take it as obvious that (sensual) perceptions are considered as imaginations27. To find out what perceptions are beyond perceptions it must be granted that knowledge is possible, otherwise all statements about perceptions lack in epistemological evidence and are mere assumptions or constructs – in both cases not suitable to stand at the very beginning of an epistemology. Furthermore, epistemologies that deny the possibility of knowledge are self-defeating. For Steiner his epistemology was of great importance, since it laid the philosophical basis for the possibility to gain not only ordinary but also “higher knowledge” on a scientific basis. Without this one could argue, all that what could be experienced by practicing the proposed exercises (aiming to acquire higher knowledge), is a mere product of fancy, fantastic ideas produced by the brain, even if the individual experiences it as “reality”; with other words, it would have no value in respect of deeper insight into the “real world”. A general belief says that concepts brought forward in human mind are subjective representatives of “world”. “World” is finished and functioning also without humans or human thoughts. Steiner challenges this position: He considers it as a prejudice to declare the world as complete without thinking: Doesn’t world develop thinking with the same necessity in the human head as it develops the blossoms of a plant, he asks. Because the concept of the plant appears within human minds it would be a prejudice to say that those concepts are not in the same sense part of the plant as the blossom is. In comparison with the smell of a distant blossom: the place of appearance says nothing about its belonging. As the physical parts of a plant need some conditions to come into appearance (soil, humidity, temperature, light, etc.), thoughts need the condition of human mind to come to appearance, but all belong to the same plant (GA 4, p. 86f). Concepts are as objective as perceptions are. Thinking is the process of perceiving thoughts; thoughts are the essence of world, humans cannot ask for an explanatory “essence” of world beyond that one given in the idea. Those, whom the principle “idea” seems to be too “weak” to act as the essence of the world, construct a world behind the world as does the “metaphysical realism” (GA 4, p. 118ff). After having moved the essence of the world into a world behind the world, it is no wonder that similarly to Immanuel Kant’s “thing in itself ”, as a matter of principle the possibility to gain knowledge about these “transcendent” worlds get lost. Steiner denotes his own philosophy “objective idealism” (GA 1, p. 129). 27
See the difference between “Wahrnehmung” and “Vorstellung”.
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It should be mentioned that this philosophy is not accepted in wide areas of contemporary philosophy by the academic philosophic community. A possible reason could be that to accept Steiner’s theses without any “yes, but …” it would be necessary to share his perception (experience). To draw an open-minded comparison without prejudice: given that almost all humans can distinguish only black and white and there is one person able to perceive something what he names “color”: it will be difficult for her or him to prove the existence of “colors” to the others in a convincing way beyond any doubt. Philosophers might also be frightened by the idea, that acceptance of Steiner’s view would at the same time mean an acceptance of his more “esoteric” statements, but as serious scientist no one wants to come in touch with someone, who in the general academic perception is considered as “visionary” next to “mad”. On the other hand, no one is forced to reject Steiner’s philosophical view because it cannot be proved beyond any doubt. The history of philosophy shows that none of the competing thesis could ever be verified beyond any doubt and no one ever found undivided consent.
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Some concepts of anthroposophy The term “anthroposophy” is built from anthropos = human being, “sophy” from sophia: wisdom. “Geisteswissenschaft” means anthroposophic spiritual science.28 Rudolf Steiner spoke about himself as being a clairvoyant and having the second sight. He detected these abilities already in his childhood and was convinced that everybody can also develop such abilities (GA 10, p. 41). He published about 40 books as author (GA 1- GA 40) and held more than 5000 lectures on a great variety of topics. From 4500 shorthand notes another 350 books were published. Not so much his philosophical and epistemological publications, but primarily his “esotericism” made him famous and subject of heavy controversy. To draw again a comparison with a report from a foreign country: it is generally accepted in academic circles that statements have to be proved by the person uttering them. But how to prove someone, who never left Europe, that in Africa is a mountain with snow on his top? Even if a photograph could be shown: 28
“Social science” or “humanities” are not appropriate translations; see also https://en.wikipedia.org/wiki/Anthroposophy#Etymology (2013-12-09).
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the photograph might be a fake or forgery. Other witnesses might be part of a plot. To be finally convinced it would be necessary to make one’s own observations. The way to the foreign country is outlined – but it is not that simple to go compared with buying a ticket. As a result, all those reports are unproved and, what makes things worse, fantastic compared with well-known convictions. In contrast to the tendency to reduce all qualities to quantities in accordance with “Occam’s razor”29, Steiner introduced a lot of new, irritating entities. In this situation many feel to be invulnerably on the safe side without the danger to be exposed to sneering laughter, if they strengthen the established standpoint of science and therefore reject Steiner’s ideas. To survive on academic grounds this might be a reasonable decision. Steiner himself repeatedly pointed out that his work would be of no value if it would be grounded just upon belief: he hoped for critical reception where readers accept only, what they are able to prove with open minds (GA 13, p. 14; GA 127, p. 51f; GA 159, p. 351; …). As soon as the discovery is made, verification should be possible without “higher” ability (maybe similarly to mathematics or geometry: as soon as Pythagoras' theorem was found and disclosed, everybody could relatively easily convince himself upon its validity). Steiner also invited to check and correct his discoveries (GA 11, p. 99). Steiner reported in his cosmogony about the evolution of matter and of earth, evolution of man and evolution of cultures (GA 13). He names nine spiritual, hierarchical forces and their “tasks” or properties, better described as levels of consciousness (GA 93a). Humans are the tenth hierarchy. The question of evil is answered by something good but displayed on the wrong place or in the wrong time. Humans have not only one body, but apart from the physical also an “etheric” and “astral” body and the “I”. In short and very roughly characterized, the etheric body is an entity “responsible” for life processes, the astral body for sensitivity, feelings and emotions. Illness is a result, if those bodies don’t interact in a sound way. While sleeping the “I” and astral body are separated from etheric and physical body allowing them to recreate and recover. In the process of dying I, astral and etheric body separates from physical body. All such bodies can be organized in a three-folded manner, e. g. the physical body as a complex of the three systems: 1st the rhythmic system (heart, lungs and blood circulation), 2nd 29
Ockham's razor: among competing hypotheses, the hypothesis with the fewest assumptions should be selected. http://en.wikipedia.org/wiki/Occam's_razor (2013-12-09)
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metabolism and limbs, and 3rd the nervous system. Systems are not separated, but interwoven, i.e. metabolism and blood circulation are also found in nerves, but they are not dominant in nerves (GA 9). There are twelve organs of perception. Five senses are already established: sight, sense of taste, olfactory sense, acoustic and tactile sense. To accept additionally a sense for warmth, a sense of balance and a sense of movements should not be a big problem. In addition, Steiner names four more senses: life-sense (responsible for feeling pain), speech-sense (enables to differentiate between sounds and syllables), thought-sense (enables to capture thoughts of others, not necessarily attached to words, but also in gestures, pictures etc.), and an ego-sense (enables us to recognize if something is gifted with an “I”, but not as a conclusion because something looks human) (GA 169 (1963), p. 55-81. GA 206, p. 11f).30 Individual evolution is under the law of reincarnation and karma (the law of fate). Humans are always reborn as humans. Rebirth happens in average (!) alternating as man and woman, once in 500 years, in general in different societies and countries to face new conditions for personal evolution. Karma can be considered similarly to any other physical or biological law: what humans do in one life has consequences for body, character and social encounters in the next life. Here can be seen also one reason for illnesses.
Medical considerations Illness happens when “bodies” interact or penetrate each other in a bad way (GA 316, p. 207). Mainly astral body influences etheric body in a bad way (GA 13, p. 154). There is no such thing as “mental illnesses”. Mind (spirit) and soul cannot get ill. All that looks like “mental illness” is an illness of the body (GA 348, p. 39). Illness of physical body, vulnerabilities, characters and abilities are considered not only as a result of actual life circumstances, inheritance, education or socialization, but also as a result of former lives. 30
See http://www.anthroposophie.net/steiner/bib_steiner_zwoelf_sinne.htm (2013-12-08)
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One reason for “depression” is disturbed karma (GA 108, p. 195ff). Polarities: Health is not a state, but the ability to perform a pendulum motion between solidification and decomposition, ulceration and inflammation (GA 312, p. 248f). Steiner gives as example for health: If someone can walk half an hour in a fur coat at 40°C – that is, accommodate to conditions. Illness as “technique of karma”: illness as a means that the patient contacts a physician. Healing comes from the physician, not from the medical sciences (GA 316, p. 204). Physicians have to know their patients (GA 348, p. 169f). Against sick funds: the patient should have the possibility to choose as freely as possible her or his physician (GA 316, p. 204). Physicians need “courage to heal”, a justified optimism (GA 319, p. 202) and a “will to cure” (GA 316, p. 205).
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A major goal is getting patients out of passivity (GA 348, p. 156). Compliance of patients is important.
5
Organization
The anthroposophical society (AS) has its administrative center in Dornach, Swiss. There is no president, but a managing board (“Vorstand”). The members of the board reside in the Goetheanum, center of “Free School of Spiritual Science”31 and equally center of administration of the anthroposophical society.32
31
Pictures of first and second Goetheanum-building can be found at http://commons .wikimedia.org/wiki/Goetheanum (2013-12-08) 32 Anthroposophische Gesellschaft, http://www.goetheanum.org/ (2013-12-08)
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Departments (“Sektionen”) To cope with special interests of members of the AS, the “Free School of Spiritual Science” is structured into eleven departments (2012): general anthroposophic mathematical-astronomical medical natural scientific agricultural pedagogic / education visual arts / fine arts speaking and music “Schöne Wissenschaften” (Literature, linguistics / philology, aesthetics, history, philosophy, music-, history of art and cultural history) · social sciences · youth
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· · · · · · · · ·
11. Second Goetheanum, west-side. Dornach, Swiss
The heads of the departments are also members of the managing board. As heads of their departments they are not just administrators, but acknowledged specialists in their realm.
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Anthroposophic medicine (AM) - A short introduction into basic concepts
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Membership and members To become a member of the AS there is no special requirement except those every good citizen should fulfil. If someone thinks goals and intentions of anthroposophy are worth to be supported, he or she can request to be accepted as a member. Theoretically speaking, you even need not belief in anthroposophical theories but think that every effort is valuable to broaden culture and science, even if it is not main-stream, it would be sufficient to justify a membership. In reality, people come in some way in contact with a local organization of AS and enjoy the ideas they learn there. They understand that at least the organization requires some funding. As member you have the same rights and duties as in any other organization. If someone is so poor that he or she cannot afford the member-fee then this would not be a hindrance to become a member. Together there are more than 10.000 anthroposophic institutions / organizations in 103 countries. This might be companies like Weleda or biodynamical producing farms, Waldorf-schools (877 Steiner- or Waldorf-schools in 57 countries), but also local organizations where members meet to read and discuss together anthroposophic issues. The AS has about 50.000 members; organized groups in 78 countries33. It may be noticed that there are in more countries (103) institutions or organizations than organized groups (78). One reason is that those organizations use anthroposophic concepts but don’t feel the necessity to become members of the AS. For example, as a teacher you can use specific techniques how to deal with pupils, but think at the same time that the source of all of this is very questionable. As a teacher one could agree with the idea that there should be no marks but verbal descriptions how the pupil performed, that there should no pupil have to repeat a class because of low performance that “normal” children should be educated side by side with handicapped and so on, but with general anthroposophy one cannot feel comfortable. The same can be said about farmers who try to avoid insecticides and pesticides and use the specific advices Steiner gave for agriculture. This separation – accepting the results of anthroposophic investigation in a specific field for practical purpose but denying its backgrounds and how these results were found – happened already at Steiner’s lifetime to his displeasure (GA 345, p. 44). 33
Anthroposophic society 2012, see http://www.anthroposophische-gesellschaft.org/index.php?id=77 (2013-12-08)
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The “Christian Community” is not part of the AS, but fundamental concepts were given by Steiner for those, who agreed to basic concepts of Christianity but could not agree how things are handled in the traditional catholic and protestant Christian organizations, and were looking for a revival of cult. There are about 35.000 members in 32 countries34. Members of the AS can also be member of the Christian Community, though this was not the intention of Steiner. He considered the scientific approach to knowledge as given in anthroposophy by means of meditation to become aware of the idea in the reality as the true communion of humans (GA 28, p. 165) and so they are not in need for religious renewal (GA 345, p. 40ff).
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Department of Medical Sciences This department cares for all kinds of medical issues, including curative arts and curative pedagogics. Speaking in terms of conventional psychotherapy, curative pedagogics deals mainly with children, who suffer from any psychosis or neurosis or general “learning disabilities”. Since Steiner found that (human) spirit cannot get sick, all that looks like mental illness or illness of the soul is in reality the result of an illness of the body, the term “mental sick” is avoided and replaced by “seelenpflegebedürftig”, meaning “in need of caring for the soul” in relation to the threefold structure of the human being, e. g. spirit, soul and body (GA 348, p. 39f). The figures published for 2012 in Europe are: AM is practiced by more than 2700 fully AM trained licensed medical doctors in 22 European countries. AM is an “add-on” to the normal education as a medical doctor on an accredited university. This is not only for the safety of patients but also to avoid conflicts with national laws dealing with charlatanism. Furthermore, having studied two different medical systems supports and promotes open-mindedness of physicians. Anthroposophic remedies are prescribed by about 15.000 physicians with various levels of training.
34
The Christian Community, see http://en.wikipedia.org/wiki/The_Christian_Community, 2012 and Christengemeinschaft http://de.wikipedia.org/wiki/Die_Christengemeinschaft
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Anthroposophic medicine (AM) - A short introduction into basic concepts
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AM is offered in 24 hospitals in five member states of the European Union and Switzerland. In 14 of those accident and emergency services are provided. Two of those are university teaching hospitals35. AM is provided in more than 120 outpatient centers. In such canters at least one physician and at least one anthroposophic therapist are working. Such centers are located in 14 member states of the European Union, in Norway and in Switzerland. Anthroposophical therapies are provided by more than 7000 anthroposophical therapists, (“classical anthroposophical therapies”) and nurses. AM is provided in more than 500 institutes for people with learning disabilities in 19 member states of the European Union. AM is regularly taught at universities and medical schools in seven member states of the European Union and Switzerland. In Germany and Switzerland there are university chairs for AM.36 Head of the Department since 1988 is Michaela Glöckler, MD. She is also responsible for the international coordination of AM (“IKAM”).37 IKAM offered (2011) postgraduate medical training in Chile, Philippines, New Zealand, Japan, USA, Taiwan, Ukraine and Russia.38
35
One of them is the University Witten/Herdecke in Germany. The faculty for medicine was top ranked October 2013 for best study conditions nationwide https://www.uni-wh.de/aktuelles/detailansicht/artikel/medizinstudium-der-uwh-belegt-1 -platz-im-fakultaetenranking-des-hartmannbundes/ (2013-12-05) 36 Facts and Figures of AM, 2011: http://ivaa.info/userfiles/file/Facts_and_Figures_AM_Oct_2011Final_Public.pdf (2012) 37 Staff of the department for medical sciences, see http://www.medsektion-goetheanum.org/home/mitarbeiter/ 38 Jahresbericht der Medizinischen Sektion, see http://www.medsektion-goetheanum.org/EYED2/files/file/DE_Med_Sektion_Jahresberi cht_%202011.pdf (2012)
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6
Critics and discussion
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Anthroposophy is not a science It is highly dependent on how “science” is defined. It is generally accepted, that more than one individual can make independently observations in a specific area of interest, and this observations can be compared and discussed by the scientific community. This should also be true for anthroposophy. Steiner gave a lot of instructions on “how to gain higher perceptions” with the help of sensual organs that have to be developed with exercises (GA 10, 13, 245, 267, 268 to mention a few). Nevertheless it looks that only few if any could gain a level similar to that of Steiner. Steiner has another approach to science. His key is not mainly the possibility that more than one can make the same observations, but the methodology on how to deal with observations. He provided his work “Philosophy of Freedom” with a subtitle: “results of psychic observations based on scientific methodology”39. For spiritual sciences the field of observations has changed, but not the methodology: perceiving and thinking about the perceptions, checking and rechecking the results. An important difference to science is the experiment. Whilst in science experiments can be designed and independently repeated, this cannot be done for spiritual worlds. Steiner discusses the idea that several persons with higher perceptions should observe the “aura” of someone and their descriptions should be compared and evaluated by “normal” scientist to find out if there is any concordance and, having interrogated the person whose aura was judged, if she or he reports the same thoughts as the observers / seers found out from judging the “aura”. This would not work, since in contrast to the “normal” world the observers cannot force a higher perception in relation to a specific question (GA 9, p. 205f). This might sound like an immunization of anthroposophic concepts against scientific critics, but as a phenomenon it is well known and accepted in artistic fields: nobody would blame a composer if he or she cannot force in any situation at any time the invention of a new melody. This would in no way falsify the compositions already created. As soon as a new melody is communicated it can be subject to scientific investigation.
39
„Seelische Beobachtungsresultate nach naturwissenschaftlicher Methode” (GA 4)
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Persons who have undergone a scientific education are better prepared for concentration and meditation since he or she is trained in a methodology that facilitates objective observation and thinking (GA 329, p. 294).
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Anthroposophists are sectarians As mentioned, Steiner wanted readers that didn’t just belief what he said, but would check his findings (GA 13, p. 14f). As this turned out to be rather difficult, many readers resigned on having own observations in higher regions and are satisfied with the impression Steiner’s words and his way of speaking made on them, and develop a kind of fundamental trust into his words. They behave similarly to technicians, who restrain themselves from scientific investigations, but take the results scientists developed, to make them useful for everyday life. As a result, having lack of own insight, things get difficult if anthroposophists discuss their beliefs with non-anthroposophists: either they stress a dogmatic position or retract from discussions, being aware of not being able neither to put forward convincing arguments nor to show how the other can easily make himself those observations that would be convincing. At this point it should be mentioned that even if everyone could make those observations it would still be a question of interpretation on how to understand the phenomenon. For thousands of years humans saw the sunrise and sunset, but it was until Copernicus the conviction that the sun moves around the earth. Steiner himself, though giving a lot of advice on how to develop own perceptions on “higher” fields, didn’t think that this was necessary for the majority (GA 219, p. 71f) but emphasized the necessity to understand and check with a “healthy mind” what he reported. He compared the situation with normal science, where everyone can think about that what astronomers or biologists found without the need to be an astronomer or biologist himself (GA 305, p. 94).
Steiner accused to be a racist Scattered in his work there are some passages that can be interpreted as “racist”. A special sensitivity against racism was developed in Europe after World War II. As a consequence, in some European countries a prohibition of Steiner’s work because of alleged racism was under discussion but never realized. Reading those
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passages in context shows that there is no racial hatred intended. In contrast, anthroposophists (but not only) should free themselves from any genetic or cultural imprint and bridge in this way the gap between nations and races. The term “race” should have lost any significance in our time. People should encounter each other as individuals, not as members of races or nations (1909, GA 117, p. 151ff).
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Contradictions found in Steiner’s work This is always a crucial point, if there are contradictions found in a system. To be honest, if one finds contradictions within the work of a philosopher, one would soon put it aside. Already at Steiner’s lifetime scholars found contradictions in his work and confronted him with this. Steiner replied that some find already contradictions where only a situation is described from different viewpoints. Steiner considered it as necessity that the description of truth requires plurality (GA 162, p. 140f). Already 1901 he wrote that anyone who cannot read his ideas without prejudice will find one contradiction after another (GA 7, p. 11). In another case he quotes an objection because once he spoke about Plato’s philosophy as one of the most significant, but another time he argued against Plato’s concept of separation of ideas and perception as being of no relevance for nature (GA 6, p. 214f). Steiner’s point: this is no contradiction at all; in this case something is most significant but wrong at the same time. As common in western culture, contradictions have to be avoided. To make things more complicated, Steiner spoke about contradictions in life that can’t be avoided, but if there are contradictions, focus should be laid on them and the contradictions should be clearly kept in mind and not be ignored to maintain a consistent world-view. Contradictions are important occasions for clear and accurate thinking (GA 254, p. 116).
Theories proofed false by sciences If there are results of spiritual science contradicting findings of “normal” science, anthroposophists should feel irritated (GA 62, p. 96). When Steiner says that there is no contradiction between findings of spiritual sciences and the true 218
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Anthroposophic medicine (AM) - A short introduction into basic concepts
findings of sciences (GA 62, p. 484), then it opens a backdoor because as soon as there are contradictions, anthroposophists can argue that in this case it is not a “true finding” of science. This way of argumentation can support the impression that anthroposophists are sectarians and immunizing their belief system. In fact, there are some words Steiner said, being fully conscious to do so in contradiction to generally accepted textbook knowledge, for example in respect to the function of the heart, brain and “motoric nerves”, using formulations similar to “as long as people believe that …” (GA 303, p. 208).
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Predictions did not come true For those looking for orientation and some kind of proof in advance if it is worth to undertake the effort to study anthroposophy predictions made that are not plausible but came true would be such hints. There are only very view predictions Steiner made in his published books, more can be found in his lectures later published with GA-numbers beyond 40. So for example he predicted that there will be soon a return to mercury-based medications against syphilis after a period of not so efficient mercury-free preparations (GA 348, p. 320f). This was 1922/23. To judge, if in this example a prediction failed to come true, it is necessary to decide, if this words from Steiner were meant as a “prediction” (as the result of an anthroposophic-scientific investigation) or were just a personal expectation. Furthermore, there might have been a return to mercury-treatment in a period before modern antibiotics where invented. Another question is the meaning of “mercury” in the context of AM: it might mean the same that chemists mean: the element with number 80 in the periodic table of elements. But being aware of alchemical relations anything else exerting “mercurial” effects could be considered as “mercury”. In another case the author tried to verify a statement made by Steiner: when subjects fall asleep lying habitually on the left or right body side, this will have a negative influence onto the sight of the respective eye (this eye get a little(!) “weaker”, “weak-sighted”) (GA 352, p. 93). A questionnaire in regard to sleeping habits and differences in sight (diopters, preferred “handedness” of one-eyed looking) of n=498 subjects could not support the – maybe wrong – (hypo)thesis; possible reasons (what are the correct parameters to measure “weak sight”) were discussed (Klünger, 1995).
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Finally it has to be accepted in accordance to basic anthroposophic epistemology that there is always the possibility to err (GA 11, p. 23, 99f, GA 107, p. 312), but detecting a misapprehension can be considered as an evidence for the existence of a non-deterministic human spirit (GA 115, p. 259).
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Anthroposophy prevents critical thinking The opposite is intended: Steiner again and again stressed the importance of clear and exact thinking (e. g. as daily exercise as described in GA 245, p. 15). Misunderstanding could arise if reading passages like those, where Steiner says, that devotion for truth and abstain from critics is important for scholars who will gain higher knowledge. But reading the context of those advices, it should be clear, that the devotion is not for persons, requesting blind belief, but for truth and knowledge. If someone wants to learn something he or she has to be open for the new and not start to criticize from the beginning. The attitude of criticism prevents the evolution of organs for higher perception (GA 10, p. 19f). Children who grow up in a culture, where they are trained from the beginning to criticize everything new from the viewpoint what they had learned already, will clearly have problems to learn something new that doesn’t fit the picture they made up already. With other words, you cannot be open for new ideas or experiences if you insist on your prejudices and take them as measure. Another point is related to what was mentioned before in connection with “anthroposophists are sectarians”. If, for example, someone insists on explaining the world with the help of “etheric” or “astral” bodies, but just use the words without being able to show how those “bodies” interact with matter or what can be really explained in an understandable and comprehensible way with the help of such bodies that normal science cannot explain, then one could argue, anthroposophy makes people belief in mystic, irrational things and prevent them from clear thinking. However, not anthroposophy should be blamed for this because Steiner’s intention was that world should be understood and not be described by new words just being learned by heart.
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Anthroposophic medicine (AM) - A short introduction into basic concepts
AM is not evidence based and has no effect I don’t know myself double-blind, randomized three armed (drug, established drug, placebo) studies on AM, as they are common and “state of the art” in western medicine. Without those studies it could be said, that there are no evidence-based effects. However, anthroposophic physicians and their patients see things differently. Accepted that AM should verifiably cure diseases the situation is not satisfactory as seen from common scientific view.
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AM is killing children because of avoiding vaccination In European countries more and more parents don’t obey to advice of physicians and national health agencies that strongly advice vaccination for a series of childhood diseases that might – in some rare cases – be deadly or result in permanent injuries. The issue has been broadly discussed, because vaccination itself is also not completely without dangers. From AM there has also to be considered that childhood diseases have an important influence on psychical and physical evolution of children. Illness is nothing that should be avoided at any prize, but plays an important role in human evolution (GA 159, p. 178). Therefore parents who are influenced by anthroposophical ideas even more than average population try to avoid vaccination, taking the risks that in rare cases the illness might have, but believe in the profit from the expected benefits of the overcome illness. Steiner himself, though “responsible” that his scholars got the idea of the benefits of children illnesses for their evolution, was no sectarian at all, as he explained that in a situation, where all (normal) children are vaccinated, children of anthroposophists cannot / should not stay aside and should not avoid vaccination (GA 314, p. 288, 343). AM is inhuman because making humans responsible for their illnesses Even without anthroposophy there is a strong belief that the way of life (drinking, smoking, dangerous sports, contact with dangerous substances or radioactivity, stress) can be made responsible for a good portion of illnesses of a person. Anthroposophy considers human life in a framework of karma. Some kind of illnesses might have their origin in past lives. Furthermore, illnesses are a means of fate to promote personal evolution – but not in a Darwinist sense. In this
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respect one could say that humans are responsible also for their illnesses. In general, whatever the reason of an illness might be, the physician’s task is to do his or her best that this illness is cured. As in general he or she is not able to see the karmic reasons, they should abstain from any such judgments or suggestions. As it might be the fate of the patient to get a specific illness, it would be at the same time the fate of the consulted physician to deal with the patient and his illness. The objection of “cruelness” would be true if the patient would be let without treatment of his illness.
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The claim to be an anthroposophic physician is mostly a betrayal of the patient From the very beginning of AM there was an ongoing dispute whether an anthroposophic physician has to have own insight into “higher worlds”, otherwise he or she would not be allowed to claim his therapy as “anthroposophic”. This argument can be used in any other context where a practice is attributed as “anthroposophic” (education, agriculture, art, …). For practical purposes it looks acceptable to mark something as “anthroposophic” if it is a) at least based on indications given by Steiner and b) this relationship is emphasized. As a consequence, every failure of an anthroposophic physician redounds upon whole anthroposophy and is taken by critics as proof that anthroposophy is an incredible belief system next to madness or quackery. On the other hand it is at least desirable that physicians who characterize themselves as “anthroposophic” undertake a steady and serious effort to develop themselves to what was called “higher experience”.
Abbreviations AM Anthroposophic medicine AS Anthroposophic Society GA refers to “Gesamtausgabe”, the collection of all publications of Rudolf Steiner IKAM International Coordination of Anthroposophic Medicine40
40
IKAM: see http://www.medsektion-goetheanum.org/en/home/ikam/
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Anthroposophic medicine (AM) - A short introduction into basic concepts
Literature
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Only some of the books are translated to foreign languages. For reference the German original titles are listed here. GA 1 Einleitungen zu Goethes Naturwissenschaftlichen Schriften. Zugleich eine Grundlegung der Geisteswissenschaft, 1884/97. GA 2 Grundlinien einer Erkenntnistheorie der Goetheschen Weltanschauung, mit besonderer Rücksicht auf Schiller, 1886. GA 3 Wahrheit und Wissenschaft. Vorspiel einer »Philosophie der Freiheit«, 1892. GA 4 Die Philosophie der Freiheit. Grundzüge einer modernen Weltanschauung. Seelische Beobachtungsresultate nach naturwissenschaftlicher Methode, 1894. GA 6 Goethes Weltanschauung, 1897. GA 7 Die Mystik im Aufgange des neuzeitlichen Geisteslebens und ihr Verhältnis zur modernen Weltanschauung, 1901. GA 9 Theosophie. Einführung in übersinnliche Welterkenntnis und Menschenbestimmung, 1904. GA 10 Wie erlangt man Erkenntnisse der höheren Welten, 1904/05. GA 11 Aus der Akasha-Chronik, 1904/08. GA 12 Die Stufen der höheren Erkenntnis, 1905/08. GA 13 Die Geheimwissenschaft im Umriss, 1910. GA 27 Grundlegendes für eine Erweiterung der Heilkunst nach geisteswissenschaftlichen Erkenntnissen, 1925. GA 28 Mein Lebensgang, 1923/25. GA 62 Ergebnisse der Geistesforschung, 1913. GA 93a Grundelemente der Esoterik. Notizen von einem esoterischen Lehrgang in Form von einunddreißig Vorträgen, 1905. GA 107 Geisteswissenschaftliche Menschenkunde,1908/09. GA 108 Die Beantwortung von Welt- und Lebensfragen durch Anthroposophie. Einundzwanzig Einzelvorträge und zwei Fragenbeantwortungen, 1908/09. GA 115 Anthroposophie - Psychosophie - Pneumatosophie, 1909/11. GA 117 Die tieferen Geheimnisse des Menschheitswerdens im Lichte der Evangelien. 1909. GA 127 Die Mission der neuen Geistesoffenbarung. Das Christus-Ereignis als Mittelpunktsgeschehen der Erdenevolution, 1911. GA 159 Das Geheimnis des Todes. Wesen und Bedeutung Mitteleuropas und die europäischen Volksgeister, 1915. GA 162 Kunst- und Lebensfragen im Lichte der Geisteswissenschaft, 1915.
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Gerhard Klünger GA 169 Weltwesen und Ichheit, 1916. GA 206 Menschenwerden, Weltenseele und Weltengeist – Zweiter Teil - Der Mensch als geistiges Wesen im historischen Werdegang, 1921. GA 219 Das Verhältnis der Sternenwelt zum Menschen und des Menschen zur Sternenwelt. Die geistige Kommunion der Menschheit, 1922. GA 245 Anweisungen für eine esoterische Schulung (5. Aufl. 1979), 1903/13. GA 254 Die okkulte Bewegung im 19. Jahrhundert und ihre Beziehung zur Weltkultur, 1915. GA 267 Seelenübungen. Band I. Übungen mit Wort- und Sinnbild-Meditationen zur methodischen Entwicklung höherer Erkenntniskräfte, 1904/24. GA 268 Mantrische Sprüche. Seelenübungen Band II, 1903/25. GA 277 Eurythmie - Die Offenbarung der sprechenden Seele. Fortbildung der Goetheschen Metamorphosenanschauung in der menschlichen Bewegung, 1918/24. GA 277a Die Entstehung und Entwickelung der Eurythmie. Erster Kurs - Das dionysische Element, Zweiter Kurs - Das apollinische Element, 1912/25. GA 281 Die Kunst der Rezitation und Deklamation, 1912/28. GA 283 Das Wesen des Musikalischen und das Tonerlebnis im Menschen, 1906/23. GA 291 Das Wesen der Farben, 1921. GA 303 Die gesunde Entwickelung des Menschenwesens. Eine Einführung in die anthroposophische Pädagogik und Didaktik, 1921/22. GA 305 Die geistig-seelischen Grundkräfte der Erziehungskunst. Spirituelle Werte in Erziehung und sozialem Leben, 1922. GA 311 Die Kunst des Erziehens aus dem Erfassen der Menschenwesenheit, 1924. GA 312 Geisteswissenschaft und Medizin (Spiritual Science and Medicine), 1920. GA 313 Geisteswissenschaftliche Gesichtspunkte zur Therapie (Anthroposophical Spiritual Science and Medical Therapy), 1921. GA 314 Physiologisch-Therapeutisches auf Grundlage der Geisteswissenschaft. Zur Therapie und Hygiene, 1920-1924. GA 315 Heileurythmie (“Curative eurythmy”), 1922. GA 316 Meditative Betrachtungen und Anleitungen zur Vertiefung der Heilkunst, 1924. GA 317 Heilpädagogischer Kurs (“Curative Education”), 1924. GA 318 Das Zusammenwirken von Ärzten und Seelsorgern (“Pastoral Medicine”), 1924. GA 319 Anthroposophische Menschenerkenntnis und Medizin (“An Outline of Anthroposophical Medical Research”), 1923/24 GA 327 Geisteswissenschaftliche Grundlagen zum Gedeihen der Landwirtschaft. Landwirtschaftlicher Kursus, 1924.
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Anthroposophic medicine (AM) - A short introduction into basic concepts GA 345 Vorträge und Kurse über christlich-religiöses Wirken, IV. Vom Wesen des wirkenden Wortes, 1923. GA 348 Über Gesundheit und Krankheit. Grundlagen einer geisteswissenschaftlichen Sinneslehre, 1922/23. GA 352 Natur und Mensch in geisteswissenschaftlicher Betrachtung. Band VI, 1924. Bockemühl, Jochen. (1973). Vom Lesen im Buche der Natur am Beispiel des Klatschmohns (Papaver rhoeas L.). Elemente der Naturwissenschaft (1) 18, 1-13. Fyfe, Agnes. (1984). Die Signatur des Uranus im Pflanzenreich. Stuttgart: Verlag Freies Geistesleben. Hauschka, Margarethe. (1978). Rhythmische Massage nach Dr. Ita Wegman. Menschenkundliche Grundlagen. Göppingen: Schule für Künstlerische Therapie und Massage. Klünger, Gerhard. (1995). Sensorische und motorische Lateralität unter besonderer Berücksichtigung der Einschlaflage aufgrund einer Hypothese von Rudolf Steiner. Diplomarbeit, Institut für Psychologie, Universität Wien. Leroi-von May, Rita. (1953). Die Ernährungslehre Dr. Rudolf Steiners als Grundlage einer Diät für Tumorgefährdete und Tumorkranke. Mitteilungsblatt des Vereins für Krebsforschung, 369-402.
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Picture credits 1. Bushes of Mistletoe on trees, p. 193; Lange Allee Eckardsau, Austria 1980, by the author. 2. Rhythmic heart massage, p. 195; Margarethe Hauschka, 1978, p. 154, by courtesy of Anja Weidtke, Margarethe Hauschka Schule. 3. Wet in wet technique: “blue”, p. 196; by the author. 4. Layer-technique: “Circle of colors”, p. 198; by the author. 5. Copper chloride biocrystallization, control sample, p. 202; by courtesy of Renate Rautenstrauch, laboratory of Verein für Krebsforschung, Arlesheim, Hiscia. 6. Fresh Brussels Sprouts, p. 202; http://www.fiv.ch/page13/page3/page3.html, Abb. 3.7 and 3.10, by courtesy of Ursula Graf, Forschungsinstitut für Vitalqualität. 7. Capillary-dynamolysis (“Steigbild”), p. 203; Agne s Fyfe, 1984, p. 2, by courtesy of Dagmar E. Seiler, Verlag Freies Geistesleben. 8. Sequence of 30 pics from daily harvested mistletoes, p. 204; Agnes Fyfe, 1984, p. 13, by courtesy of Dagmar E. Seiler, Verlag Freies Geistesleben.
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Gerhard Klünger 9. Flow Contour Analysis, p. 205; http://www.stroemungsinstitut.de/prospect.htm, by courtesy of Manfred Schleyer, Institut für Strömungswissenschaften, Herrischried. 10. Sequence of leaves of Papaver rhoeas L., p. 207; Author: Jochen Bockemühl, 1973, Abb. 2, p. 4-5, by courtesy of Barbara Schmocker, Goetheanum, Naturwissenschaftliche Sektion. (Leaves rearranged). 11. Second Goetheanum, west-side. Dornach, Swiss, p. 214; URL: http://en .wikipedia.org/wiki/File:Goetheanum_Dornach.jpg Author: Wladyslaw. This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.
I would like to thank Dr. med. Robert Schigutt for his valuable contributions.
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On the author Gerhard Klünger, Doctoral study of chemistry and physics, Six years employment in complementary cancer research, Diploma study of psychology, Propaedeutic studies in psychotherapy, Certification as secondary teacher for chemistry, philosophy, psychology and pedagogics, doctoral study of pedagogics (philosophy), More than twenty years engaged with Constructive Realism
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Dr. Morita’s Psychophysical Therapy Influenced by Zen Buddhism A Comparison of the Thinking Principles of Morita and the Cognitive Scientist M. Schlick Hisaki Hashi (University of Vienna)
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Abstract In Western-style medicine it is customary to diagnose the symptoms of an illness, to define its cause and, if necessary, remove it from the human organism by way of a surgical intervention. In surgery and in internal medicine this method is usually successful. But for a number of psycho-physical problems this is not the best method of treatment. Furthermore, the problem of what is the essence of “suffering” often eludes definition in psychology. If the cause of individual suffering is defined in the course of dialogue therapy, the patient’s psychological situation will not remain static at the defined position; there is always the possibility of change. Intelligent patients capable of complex mental processes may have their reservations vis-à-vis their therapist: They may have their doubts whether this particular therapy will provide an effective cure for their sufferings. Some of them will try to analyze the methodical correctness of the therapist. Here it is necessary to consider what the essence of “suffering” is. A possible solution to this problem might be found in a comparative Science of Cultures, Languages and their basic Ways of Thinking. The “Morita Therapy” developed by Dr. MORITA Masatake (1874–1938) and his successors shows a unique approach to overcome this problem, as a therapy as well as a method of “self-healing” of psycho-physical disturbances. In his youth, Dr. Morita himself suffered from obsessive neurosis and anxiety psy-
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chosis. He was a difficult patient on whom the classic Western style psychotherapy did not have an effect. The turning point for Morita to overcome his illness and find his way of self-recognition and self-healing was the practice of Zen Buddhism and its psychical and intellectual influence on both body and mind. Some think that it may be an innovative contribution to conventional psychotherapy, whereas others hold that the Morita Therapy lacks a well-founded scientific basis. I have a still different viewpoint: As a medical doctor Morita has not left a scientific theory backing his therapy, while the therapy itself is an original system combining psycho-physical medicine, therapy and anthropology. In my lecture I will compare the thinking system behind the Morita Therapy (the so-called “Art of Self-Healing”) with the basic principles of Moritz Schlick’s analytical thought and cognitive science (Vienna Circle, Lecture held in 1933/34). This may provide some useful impulses for recognizing what is an efficient method to overcome psycho-physical problems, which may so easily arise within the complex dimensions of our lives governed by the networks of a globalized world.
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Introduction The “Morita Therapy“ receives a well-organized feedback from various readers in the international area. Some people think that it may be an innovative contribution to conventional psychotherapy, whereas others hold that the Morita Therapy lacks a well-founded scientific basis. I have a still different viewpoint: As a medical doctor Morita has not left a scientific theory backing his therapy, while the therapy itself is an original system of psycho-physical medicine, therapy and anthropology. The following is an outline of the principles of the Morita Therapy, which differs greatly from the methods of Freud, Jung and others. Morita does not say much about the analysis of the pathological cause of the neurotic or psychic symptoms. He defines the cause of obsessive neurosis and panics as being a priori inherent in the nature of individual patients whose psyche is prone to a repeated reproduction of hypersensitivity or panic attacks, thereby triggering an exclusively negative approach to any problem. A diagnosis of the pathological causes, whether they originate from childhood experiences, from the parent
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Dr. Morita’s Psychophysical Therapy Influenced by Zen Buddhism
relations or from unsuccessful human interrelations, is not regarded as a central issue of the Morita Therapy. 1
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The Method of Morita – based on Buddhist way of thinking Morita presumes that the therapist may accept this basic tendency a priori as part of the inborn nature of his patients, and that this presumption is to determine the basic dimension of the therapy. This readiness for acceptance does not only belong to the therapist, but also to the patients, to define the initial position of their healing process. Those familiar with the methods of Freud or Jung may believe that the Morita Therapy has neglected the pathological discourse. One principle of the Morita Therapy is that a pathological examination or analysis of the causality of the symptoms would – for some patients case by case – lead to an increase in their panic attacks, their inborn nature not being subject to change. Therapists will prescribe medication according to the diagnosis of the symptoms. If the condition of the patient gets worse, a higher dose will be prescribed. With psychotic conditions this may have an adverse effect by which patients are seen as objects to be diagnosed by the therapist, disregarding their potential of self-healing. If the therapy relying on an increased dose of medication is not effective, the patients will suffer defeat by losing their self-confidence. The Morita Therapy, on the other hand, has a different approach: The inclination of the patient to reproduce panic attacks is accepted as his inborn, very human nature. On this basis a joint working method is evolved by therapist and patient. Morita underlines that the inborn nature of psychosis is not an illness which must be shamed or rejected in a society. It forms the basis for any human effort striving for higher achievement in order to master one’s life in a satisfying manner. Neither ignored nor discriminated the patient will be lead by the doctor to a communicative field of the co-existence in which they build up the way of the self healing for the human nature. 2 Seen in the light of comparative philosophy, this tenet of the Morita Therapy is related to Buddhism. Instead of a superstructure of pathological symptoms, Morita favours an absolute acceptance of the neurotoc-psychotic nature of the patient primarily as a basis of one’s own pure humanity. It can be seen that this open readiness for and acceptance of a given phenomenon corresponds to the basic ideas of Buddhism as a philosophy: Man’s whole life is “duhk̟ ha“ (suffering). Birth, ageing, sickness and death belong to every individual. Encountering a
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spiteful person means suffering, just as the separation from a beloved one or the loss of power or of an accomplishment means suffering. Suffering is not something to be removed as an object, but an inborn basic phenomenon that has to be accepted by man. 3 Thinking and acting of therapist and patient will be determined by the way in which we handle this basic phenomenon, strengthening the positive side of our inborn nature, and finally transgressing the phenomenon of suffering. – Here a dichotomy differentiation of therapist and patient is not in the foreground, neither the definition from the pathological analysis nor a visualization of the substance of sickness executively (which is important in analytical thinking). Of course various symptoms of panic attacks, anxious or obsessive psycho-phenomenon of each kind are observed through the dialogue therapy most carefully. Suitable medication is one of the basic principles of the Morita Therapy; but it should not be actualized without an integration of well coordinated balance of the body and mind f the patient. The orientation of the patient’s own mind grown up from him/herself is the irrefutable part by which this therapy contributes a most suitable indication to develop and strength one’s own power for the self healing. 4
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Definition of the pain in analytical way of thinking A reference to Moritz Schlick, one of the prominent representatives of traditional scientific theory, seems appropriate for comparative reflection. In his cycle of lectures Die Probleme der Philosophie in ihrem Zusammenhang (Winter Semester 1933-34) Schlick propounded the theory that the ego / self (Ich) as such was certainly a subject of metaphysics and ontology, but could not be made a topic of cognitive theory of science. Reasons for this were (1) that statements of a self are always subjective expressions of an individual, e.g. feeling pain is a highly subjective phenomenon which can be described only in correlation with an ego or self as a subject feeling pain, (2) the problem is that the self-feeling cannot be defined in a positivist, material and scientific way, because it is always related to a personal pronoun, in the singular form, always connected to a subject statement form. 5 Against the horizon of the Morita Therapy und the tenets of Buddhism, I would point out that this theory does not conform to Buddhist philosophy. Today one can establish neuronal physiological causes of the phenomenon of feeling pain: The organism which receives an unusual stimulus, transmits 230
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Dr. Morita’s Psychophysical Therapy Influenced by Zen Buddhism
stronger signals via the central nervous system to the cerebral regions. This process is a reproducible phenomenon of pain which can be observed and measured at the body which experiences the pain. Psychic suffering can be investigated by examining the hormone level of cerebral cells. In Buddhism another phenomenon becomes relevant: Regardless of the medical method used for diagnosing the causes of pain, the patient is bound to suffer. If the cause is found in an imbalance of the neuronal hormone level, for instance in a lack of Serotonin, the therapy will resort to anti-depressants, which will cause the Serotonin to be retained in the cerebrum for a longer period. In this case the patient’s state of mind will experience an improvement. This kind of diagnosis and therapy may be helpful, but they are not exhaustive. Psychotic patients fall ill not only because the material substance of their organism is affected but also because this affection triggers off an orientation of the mind in close connection with the patient’s free will and the liberty of action. It is because neurotic- psychotic patients have an inborn inclination to look at things in a depressive, negative way, that they need an inner reinforcement, a reorientation in the content of their consciousness. If this reorientation does not take place, medication alone will not achieve the desired results. 6 The principles outlined by Schlick are valid within the frame of his cognitive theory. The prerequisite is that any subject that cannot be proved in a scientific, positive way, is to be excluded from discussion. I think that this viewpoint holds true within the limits of cognitive theory but not for therapy of psychosis, because the causes of this condition are not restricted to a substantial matter that can be positively defined. Psychic illnesses have their causes in the orientation of the patient’s mind, in the connection of their relations to their environment. An integrative method is necessary to help them on the way towards health. This method must rely on a medical diagnosis just as well as on a co-operative joint dialogue of two individuals or “selfs“ (“selves”), the therapist and the patient.
The core of the Morita Therapy for a well setting of mind To return to the Morita Therapy: Does it include a special action, sports or music therapy? Morita suggests that neurotic psychosis results from an increased tension between the patient’s own perception of wish-fulfilment and a reality running counter to this. The stronger the involvement in one’s own desires, the stronger the suffering of the psyche. It is important for psychotic patients to
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recognize this pattern in order to arrive at a different mindset while the efforts to the healing and self healing are never given up: “Let it be as it is. Let us leave things as they will develop by themselves spontaneously”: This is not indifference, passivity in an ignorance or idleness, but a profound, judicious composure, a kind of “extinguishing and cleansing of a fiery craving for wish-fulfilment here and now“. This thought of Morita is based on the idea, “The Reality is the best Truth”, a term of Zen Buddhism, i.e.: The reality in here and now which could not immediately changed drastic by one’s own effort, has to be and should be accepted in a calm mind during which the environment is changing from itself and also in attend of one’s cautious view and continuous effort. 7 Let it be as it is; in the midst is the individual self, a free-self finding the way in his or her life freely. Of course, this kind of self control is by patients of panic attack or anxiety psychosis in a heavy grade almost impossible. For this case is guided by Morita’s therapy, that the patients should keep an absolute calmness in bed several days, until the motives for occurring a panic attack or anxiety of any kind will be exhausted completely. Anyway, the core of the Morita Therapy reminds us a similarity to the thinking and acting way of Zen Buddhism: If we have a causality to angry or frustration, unsatisfied emotions of any kind, let us concentrate our insight without explosion, screaming or attack to anyone, to clarify why we have to be angry and how far the cause of our angriness is correct. This kind of self-critical reflexion can be executed, until the right reason of our angry is exhausted. Just by this point the energy of angriness, panic or anxiety find out a turning point by which the negative energy could be transmitted to the positive thinking and acting energy. 8 Morita’s “Change in Thinking“ aims at a kind of “nirvān̟a“, the “quenching of fiery greed“ in original Indian Buddhism. A reinterpretation in East Asian Zen Buddhism has found the formula “to be free from suffering, in a transparent state of mind resulting therefrom“.9 The patient must first calmly look at the pattern of the origin of his suffering and realize why this has arisen and grown. If he can cling to this pattern, he may then move into the opposite direction thereby – “releasing his bonds“.
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The basic diagnose of Morita Therapy to achieve a well conditioned body The Morita Therapy prescribes the following procedure:10 At the very beginning the patient should be confined to his/her bed (for one to not more than seven days, with medication treatment). If neurotic, psychotic or compulsive panic attacks arise – “let it be as it is”. The sources of psychotic imaginings will run dry in due course. From the eighth day onwards the patient should revert to his/her normal daily routines, however, with a considerable reduction of his/her working load. He/She should at best engage in light physical work (cleaning, handicraft, sewing etc.) Regardless of whether his state of mind has improved or not, the patient should attend to the task in hand. A flowing state of consciousness should help the bodily organism to give itself up to the current piece of work. If panic attacks occur they should be disregarded – again: “Let it be as it is”. What is important is the full dedication to the task in hand. This method reminds us of the practice of integrative concentration of body and mind through the cautious breathing practised in Zen Buddhism: The physical organism is consciously stilled so that all members of the body are drawn towards an absolutely quiescent point. Concentration is directed to rhythmical breathing uncontaminated by particular thoughts or visions. Whether advantageous or not – any value judgments or calculations are to be dropped. If thoughts or visions arise, let them pass. Do not make them subjects to be fought against. Let us accept this phenomenon as inherent to the nature of our minds, while we concentrate on the original motive of life, on deep breathing and on the core of our transparent consciousness.
The misleading of “intuition” – Different status and meaning of the “intuition” in the thought of Morita (Zen Bddhism) and Schlick (Cognitive science) Suzuki Daisetz, an important Zen philosopher of the 20th century, has coined the term satori, prajñā, i.e. “intuition“, to be found in profound calmness getting a clear insight of all things.11 This may give rise to misunderstandings, especially with thinkers of an analytical orientation. Looking at Moritz Schlick and his lectures about “intuitive cognition”, one may come to the following conclusion: For Schlick and other analytical thinkers “intuition” means the emotional sensation or momentary ideas which cannot be scientifically explained. This, however,
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is not the kind of “intuition”, which Daisetz meant. I think that another translation including an explication would be preferable: a “transparent insight”, free from any sensation into the entity of the whole situation and the condition of the self in its environment. The following quotation illustrates Schlick‘s proposition of “intuition”:12 ‘This is a motion, a movement in the mind, stimulated by the environment. But it is momentary. The person who has this experience comments on this sensation and believes in a subjective way that this is a cognition: This is not true. The recognizing subject has to analyse the object he recognizes, as a deduction in the cognition process. He has to expound what has been recognized in a discursively critical way and what has not. With ‘intuition’ the recognizing subject is no longer in the position of this analytical division. Therefore intuition is never in the position of deduction of cognition.’ If some of Schlick’s followers cling to this proposition and on this basis query the scientific quality of Zen Buddhist “intuition“, this may be seen as a breach of logic, resulted from an error of translation and a lack of explanatory discourse. The “intuition” of Daisetz and other Zen philosophers is a transparent insight into a given situation and the affectivity of an individual as a distinct self (with body and mind in correlation to the environment). This is recognized by an alert, sober and clear consciousness which is aware of its own physis and its environment. Thus, it is far from an “intuition of a mystifying nature”, condemned by Schlick as lacking analytical scientificity. The following phrasing would be more felicitous: a profound insight in the midst of experiencing an active, fully concentrated, clear state of consciousness.
The comparison of the horizons of Zen and Cognitive Science In the light of comparative philosophy the following comments might be added: Contrary to the principles of analytical philosophy, the cognition of Zen Buddhism does not keep an objectivist distance in front of the thematic subject. Buddhist cognition generally means the opposite: The thinking and beholding person is part of the phenomenon itself which comprises the problems that have to be solved. In the Morita Therapy the therapist does not try to manipulate the patient, but acts as a consultant and mentor on the same level as the patient, furthering and developing the potential of self-healing of the latter. There is not division between cognitive subject and object, but patient and therapist move on 234
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a level of co-existence, the patient on his way towards developing his self-healing faculties and the therapist as his mentor, as a mediator between the sick and the sound psyche. To turn back to Schlick’s terminology and the philosophy of Zen Buddhism we have to regard the basic thinking system of Suzuki Daisetz (1870-1966, Zen thinker), Hisamatsu Shin’ichi (1889 – 1980, Kyoto School, philosopher and Zen philosopher), Akizuki Ryōmin (1921 – 1999, Zen philosopher) and Izutsu Toshihiko (1914 – 1993, linguist, orientalist, philosopher):13 The most important principle to grasp their system of thinking is that a cognition is obtained, when a recognizing subject and a recognizable object meet within the dimensions of co-existential experience. By Morita, the applied dimension influenced by the Zen Buddhist philosophy, the thinking principle is similar: Toward the relationship the therapist and patient build a field of co-existence and achieve an effective healing practice in which the subject-object (patient and doctor) goals a field of oneness. Hereby the position of subject and object is not fixed; they are in the relation of interdependency. In this relationship of therapist and patient the subject and object are constantly changing roles. For the patient the consultation of the therapist is a recognizable object and at the same time it is a part of his self-recognition, in another word the realization what he can do for himself on the co-existential level. For the therapist the further development of the patient is not only an object to be controlled, but he is a critical mediator controlling his own consciousness to monitor the effectiveness of his healing practice. Instead of a division of recognizing subject and recognizable object, there is an integrative connection, the change of subject and object roles and a reunion of both on the co-existential basis. An intermediate balance of this discourse within the horizon of comparative philosophy is that in the Morita Therapy (underlined by the Zen Buddhist interpretation of cognition) the recognizing subject (therapist) is placed in the position of a recognizable, discussable phenomenon. With purely analytical thinkers such as Schlick this is not the case.
Integration of the thinking and acting self to the scientific subject The horizon of the analyst as an analytically thinking subject cannot be regarded at the same time as the subject of his analysis clearly. If he wishes to analyse a part of his own horizon of thinking, this requires a definition of which part of the horizon of the recognizing subject is to be the subject of interpretation and
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which is not. Therefore, the parts of the recognizing subject are turned into a recognizable object. In this basic method of analytical philosophy a series of objects of thinking are accumulated, which remain untreated and eliminated from the discourse. In order to define an intractable problem in cognitive, scientific thinking the method of analysis is preferable. But the analytical method alone will not be able to expound the wide range of philosophical problems. As Schlick thought himself that “the synthetic judgement a priori concerned by Kant is not possible for cognitive science” 14, we have to reconsider that there are plenty of disciplines within the entire range of philosophical thinking which cannot rely on analytical methods alone. Thus the problem of the ego / self, the issue of the Morita Therapy and its insistence on self-healing, cannot be solved by a nominalization of the causes of mental suffering only. Similarly, the complex of problems in Kant’s antinomies (Critique of Pure Reason) cannot be solved by methods of analytical philosophy alone.15 A self-critical approach within one’s own horizon of thinking and the possibility resulting therefrom of integration into other philosophical horizons is to be most expected in our time of globalization – also from experts of analytical philosophy: And I wish that this article could be a contribution for a dialogue of a comparative medicine theory includes also interested thinkers of analytical field.
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Endnotes 1
The basic position of Morita Therapy: See the article of Hashi, published in the collected work of Wallner and Hashi, Globalisierung des Denkens in Ost und West, Nordhausen 2011: “Dr. Morita’s Psychophysical Therapy and the Way it is Influenced by Zen Buddhism” 2 Tashiro, Nobutada, morita ryōhō nyūmon (Introduction to the Morita Therapy), Tokyo 2005: sōgensha: chapter 14, 15, 16. Hashi, ibidem 2011, chapter 2. 3 Basic concepts of suffering in Early Buddhism are found in samyutta-nikāya 56. 11, majjhima-nikāya 28, 115. For the concept of karunā in Zen Buddhism see hisamatsu shin’ichi bukkyō kōgi (Hisamatsu Shin’ichi: Lectures of Buddhism ), vol. II, Kyoto 1990: Hōzōkan. 4 Tashiro, ibidem, chapter 3.3. Hashi, 2011, ibidem, chapter 8. According to the well developed medicine in our time the psycho therapists and physicians as successors of Morita develop various diagnoses and medical therapies based on the fundamental thinking sys-
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Dr. Morita’s Psychophysical Therapy Influenced by Zen Buddhism tem of Morita. One of their projects is an application of the Morita therapy to patients of schizophrenia. 5 Moritz Schlick, Die Probleme der Philosophie in ihrem Zusammenhang, Frankfurt a. M. 1986, Para. 22, „Vom Ich oder von der Psyche“. 6 In this preposition the Buddhist way of thinking is transparent that the „suffer of the soul or psyche“ could not reviewed only from a material causality but also from the one’s own orientation of his/her mind. An integration of the body and mind of the suffering one viewed from the co-existence of the medical doctor and the patient comes to the foreground. 7 “Let it be as it is” : aru ga mama (jap.); Tashiro, chap. 9. 3., pp. 136, cf. chap. 2. Hashi, ibidem 2011, chap. 6. Tashiro, chap. 3. 5. 8 We have to accent that this way of calm down is only possible, if patients of heavy grade depression would keep their absolute calmness in bed, enough sleep in getting well balanced foods, and of course also the support of well organized medication. See Tashiro, chapter 3, Hashi 2011, chapter 6 and 7. 9 Instead of the “nirvān̟a”, the basic principle of the Buddhism in general, an alternative term is used by Zen Buddhism often; gedatsu (jap.) 解脱, “overcoming one’s own border of knowledge or recognition to achieve a self liberty and self recognition in body and mind”. The active character of Zen Buddhism is shown that “nirvān̟a” is reviewed in a tight integration to the daily life as “reset of the mind in awareness and cautious view” in regarding and accenting the “self liberty and self transcendence”. Morita used in his therapist theory this term gedatsu. hanmon soku gedatsu 煩悶即解脱 Suffering (kleśa) and Awakening (bodhi) are simultaneous, both of them being in transmission. i.e.: The energy of the suffering psyche must be transformed to the positive energy for acting and resetting of the well integrated body and mind. 10 Tashiro, chapter 3.3. Hashi 2011, chapter 8. 11 Daisetz T. Suzuki: 1870-1966, one of the most well known Zen thinkers in the 20th century. See the Complete Works of Daisetz, Tokyo 1968-1970 and selected works published in various languages, for example “Prajna”, Zürich 1990: Otto Barth. 12 Moritz Schlick, „Von der sogenannten intuitiven Erkenntnis“, in: Die Probleme der Philosophie in ihrem Zusammenhang“, chapter 9, Frankfurt a.M. 1986 13 Akizuki, Collected Works vol. 1-15, Tokyo 1978-1980. Hisamatsu, Complete Works vo. 1-9, Kyoto 1994-1996; Izutsu, Die Philosophie des Zen-Buddhismus, Hamburg 1988; Izutsu, Complete Works vols. 1-12, Tokyo 1992. 14 Kant, Kritik der reinen Vernunft (Critique of Pure Reason), Hamburg 1990, B 11, A 7. Moritz Schlick, Die Probleme der Philosophie in ihrem Zusammenhang, 13th lecture, „Von der sogenannten Denknotwendigkeit“, Frankfurt a. M. 1986. p. 165. Schlick meant the
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„synthetic judgment a priori“ represented by Kant should be corrected to the “synthetic judgment a posteriori” in the pure analytical philosophy, whereby the latter must be understood as a “pure empirical sentences”. 15 Kant, Critique of Pure Reason, B 432-595, A 408-567. Even if a part of discourse of Kant is based on the analytical way, the causal logical fundament of all being could not be explained completely – not only in view if the natural sciences but also in the analytical way of thinking. A fundamental ontological approach is needed in which the analytical thinking takes important parts. A similar problematic of the aporia accompanied by the character of antinomy is found in the early Buddhist philosophy, “avyākṛta”: Concerning to this problematic see Hashi: Zen und Philosophie, Wien 2009, pp. 163. Philosophische Anthropologie zur globalen Welt, Münster/Berlin 2013, II. Main Section, chapter 5.
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Chapter 3
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The Special Situation of Psychotherapy
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Tools of Experimental Hermeneutics in Psychotherapy Science at Sigmund Freud University, Vienna A brief introduction Kurt Greiner (Sigmund Freud University) Gabriela Breindl (Sigmund Freud University) Translated into English by Martin J. Jandl, Alla Kirsha & Alexander Chernikov
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Primarily remark Reflecting methodologically on scientific work is possible by means of the epistemological concept called “strangification”. This special idea of achieving knowledge was developed by the constructive-realistic philosophy of science for the purpose to initiate reflection of science done by scientists. At first we will sketch this philosophic idea briefly, and then we will give a very short introduction into innovative hermeneutic tools and techniques (Experimental Hermeneutics) for therapy schools analysis which were developed at Sigmund Freud University Vienna (SFU) according to principles of constructive-realistic strangification.
1
Strangification: Notes on the epistemological concept of knowledge in Constructive Realism (CR)
The Viennese school of constructivist philosophy of science, Constructive Realism, is interested in the issue: What do scientists actually when they produce scientific knowledge? In respect to natural sciences the answer of Constructive
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Kurt Greiner and Gabriela Breindl
Realism reads: “The work of natural scientists is to construct worlds. Natural science is not a description, but a construction. [Naturwissenschaftliche Arbeit stellt Konstruktion von Welten dar. Naturwissenschaftliche Arbeit stellt nicht eine Beschreibung von etwas dar, sondern ist immer konstruktiv.]“ (Wallner 1997, p. 21) The Viennese philosopher of science, Friedrich G. Wallner, who is the founder of Constructive Realism names the results of scientific construction simply “micro-worlds” continuing Wittgenstein’s theory of language games. Wittgenstein claims that the world or reality that is the objective of science is pre-structured by the views of special scientific communities; hence cognition of the world is determined by a linguistic context and thus depends on this context in principle (see Wallner 1997, pp. 23ff). A famous proponent of this view beside Constructive Realism is the constructivist philosophy of science supported by the “School of Erlangen” arguing that modern physicists (apart from few exceptions) don’t share the naive-realistic correspondence theory of truth. Science as an activity of producing knowledge is not loaded with the claim that the results of this knowledge production are the so called “natural laws” as a fix representation of the one and homogenous reality. On the contrary, current physicists deal with self-produced constructions and not with objects existing without human actions that can’t be thus discovered. Physicists are no longer naturalists deciphering the world and its code, but according to this view and self-understanding their core task is making technology possible (see Zitterbarth 1991, pp. 82f). Modern physics don’t draw the divine construction plan of the world-machine, but rather generate knowledge (called “language games”, “constructions”, “micro-worlds”, or whatever) that allows to construct machines to facilitate our lifes. From the viewpoint of philosophy of science the instrumentalistic dimension of science is not problematic, but what is problematic in sciences is its self-reflexive dimension (see Wallner 1997, p. 25). That’s why we will deal with the issue of a technique of understanding that is relevant to understanding, and not with the issue of technology that is relevant to actions. Or, in other words, we will discuss the issue of knowledge, or more exactly, of self-knowledge. According to the constructive-realistic viewpoint it is a fact that scientists are not able to recognise what they do in the course of micro-world construction. Enclosed in their scientific language games – to quote Wittgenstein once more – it is not possible to obtain the necessary distance to this language game, and without distance it isn’t possible to achieve knowledge (see Wallner 1997, p. 26). “A language games structures the world in any sense […], but it is not possible to 242
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understand it. My idea is: To achieve knowledge we must transfer one scientific proposition system in the context of another one. [Ein Sprachspiel strukturiert die Welt in irgendeinem Sinn (…), es kann aber nicht verstanden werden. Es kann von sich aus nicht verstanden werden. Aber, wie ist es denn, habe ich mich gefragt, wenn wir ein Satzsystem aus einer Spezialdisziplin in eine andere übertragen?]“ (Wallner 1997, p. 26) As a consequence Wallner developed the epistemological idea called “strangification” claiming to take a proposition system X out of its original context K and to place in another context R (e.g. see Wallner 1992, pp. 82ff). This concept causes the scientist to place his theory in a different and strange context. From the viewpoint of this context R the theory X is considered, assessed, etc. newly and, that’s for sure, differently. Strangification means hence to leave the ways of thinking of a special discipline. Without referring to any meta- theoretical instances the procedure of strangification reveals implicit prerequisites of a theory unknown and unrecognised by scientists before strangification. Mostly strangification gives rise to a relativation of the original theory (see Peschl 1991, p.6). Strangification opens a new understanding of a scientific method – insights that wouldn’t be disclosed in the manner of instrumentalistic work.
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Conclusion: Strangification has a self-reflection motivating and knowledge encouraging effect on micro-world constructors. Hence, strangification is a possible way that leads to scientific (self-)knowledge and (self-) understanding.
2
Psychotherapeutic Language-games: Different ways of speaking as foundation of the manifold of psychotherapy modalities
During the 20th century neopositivist and rational-critical philosophers of psychotherapy reproached psychotherapy for the alleged lack of scientificy. Constructive-realistic epistemologists claim nowadays: There is no question about the scientific status quo of psychotherapy, and, furthermore, the unique feature of psychotherapy as a multi-pluralistic discipline serves as paradigmatic example for the 21st century science (see Wallner 1996, 2002; Slunecko 1996; Greiner 2005, 2007). The modality-pluralistic discipline psychotherapy developed a manifold of different ways of speaking about the mental and its problems – according to Ludwig Wittgenstein we can call them Psychotherapeutic Language-games. By
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application of different and complexly structured psychological concept-systems, psychotherapy can best be described as contextualizing and as an interpretation science. That is to say that psychotherapy provides coherence and creates cohesion or sense. In a constructive-realistic sense, psychotherapy is a polymorph technique of contextualizing in psychological concept-systems. Different psychotherapies construct and structure specific psychological concept-instruments (i.e. scientific ways of speaking or language-games) and applicate these instruments practically to its subject, i.e. human activities, performances and action results in order to interprete them. Supported methodologically by conceptual tools, psychotherapies set moments of misinterpretation, of dubiousness, of incomprehensibility into understandable psychological sense contexts; in short, psychotherapies make understandable what is hardly or not understandable by means of specific methods of interpretation. In this way – mainly a way of interpretation technique – psychotherapies create a manifold of contextualization knowledge and polymorph contextualization technique (see Greiner 2007; Greiner 2012; Greiner et al. 2009; Greiner et al. 2010; Greiner et al. 2012). Prominent examples for psychological concept systems are: Psychoanalysis, Behaviour Therapy, Gestalt Therapy, Person-centred Therapy, Client-centred Therapy, and Family Group Therapy (or Systemic Therapy). The different psychotherapeutic ways of speaking turned to be confusing in the last two decades, and it is nearly impossible to gain a methodological survey nowadays. Exactly the factuality of numbers of concept constructions with polymorph structure qualities founds an enormous potential ascertainable in the field of psychotherapy. More pointedly speaking, this potential is the potential to be a paradigmatic example for science in the classical European sense. Note that it is a core claim of the European science ideal that it is not only necessary to gain disposition knowledge or knowledge how to do things, but it is moreover necessary to gain insight into the own activity. Both methodological heterogeneity and procedure variety within one’s own discipline represent positive conditions for the self-reflexive strategy of the “critical view on one’s one performance”. Psychotherapists can stay within their own discipline when they strive to adequate knowledge (reflection-knowledge/knowing that) of their specific psychotherapeutical speech treatment (technique-knowledge/knowing how). The idea of gaining knowing-that within one’s own discipline will be discussed soon. According to the constructive-realistic view, psychotherapy is a genuinely autonomous discipline. In addition, the methodological status quo of psycho244
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therapeutic multilingualism makes psychotherapy to a potential model for science culture in the 21st century. Psychotherapy must, however, interprete itself as method polymorph, multi-conceptual and approach pluralistic in order to practice an up-to-day and philosophically tenable scientific identity successfully (see Wallner 1996, 2002; Slunecko 1996; Greiner 2008).
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3
Experimental Hermeneutics: How to gain reflection on Psychotherapeutic Language-games by the help of new analysis instruments based on the idea of Strangification
In consideration of our constructive-realistic discussion we have to state that the scientific idea of gaining knowing-that within one’s own therapeutic discipline is connected with our conviction that the idea of making explicit what is implicit can serve as foundation for research in psychotherapy science. Now we are going to explain our special view on basis research in psychotherapy by focusing the field of scientific actions Kurt Greiner has conceptualized and titled “Transfermeneutic Psychotherapy Science” or TPS (Transfermeneutics = Transfer + Hermeneutics). The first research programme of TPS named “Therapy Schools Dialogue” or TSD has been established at SFU Vienna by Kurt Greiner and Martin Jandl during the last six years. The main methodological procedure of TSD is a theory-analytical technique called “Experimental Trans-Contextualisation” or ExTC. During the last two years further experimental-hermeneutical analysis tools and research techniques have been developed within a second programme named “Therapy Schools Reflection” or TSR. In the scientific context of TSR we find two instruments called “Psycho-Text-Puzzle” or P-T-P and “Psycho-Picture-Process” or PPP (see Greiner 2008, 2011, 2012, 2013; Greiner et al. 2009; Greiner et al. 2010; Greiner et al. 2012; Greiner et al. 2013). It is a claim for the research and practice field of psychotherapy that the foundations of the respective approaches should be viewed in reflexive knowledge-intention and in sophisticated manner. According to our view, this procedure will solve the persistent doubt vis-à-vis the commitment of psychotherapeutic propositions. Insights into the method-relational commitment scope of psychotherapeutic propositions will increase the understanding of legitimate validity-scopes and distinctness concerning relevance and sense boundaries of these propositions and of psychotherapeutic proposition systems in general.
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3.1 Scheme of Therapy Schools Dialogue (TSD) by Experimental Trans-Contextualisation (ExTC) Therapy Schools Dialogue (TSD) is an innovative approach for researches in psychotherapy science and represents a reflective scientific alternative to usual quantitative empirical approaches of researches. “I denote my special interdisciplinary therapy schools’ or rather inter-therapeutic approach of fundamental research as Therapy Schools Dialogue (TSD) and define it as (definition) a constructively founded, dialogue experimental practice of research which is based on a theoretical-analytical method with the focus on, promotion, development and evolution of interdisciplinary reflection dialogue of psychotherapeutic systems (Micro-Realities). The goal of TSD is to create a constructive encounter opportunity amongst all psychotherapeutic approaches and modalities via the systematic development of scientific discussion- and communication modes within the disciplinary common frame of Psychotherapy (Therapy Schools Interdisciplinarity).” (Greiner 2012, 29-30) The approach for research in TSD extends the intertherapeutic field and creates the neutral base between separate methods of therapy from where dialogue encounters can take place. Until now academic psychotherapeutic research was mainly done by external positions of therapy and almost exclusively within institutional conditions of well-established social and natural scientific disciplines such as Medicine or Psychology. It was a matter of psychotherapy research from the outside. Psychotherapy research in TSD can now take place from the inside, thus “Psychotherapy research from and for Psychotherapists” and in consequence Sigmund Freud’s psychoanalytical postulate of ‘interconnection of research and healing’ advanced to one Psychotherapy Science Maxim. With the help of the technical Strangification/Alienation approach of Experimental Trans-Contextualisation (ExTC) it is possible to gain deeper insight in the implicit structure of one's own therapy school and to open new points of view concerning one’s own therapeutic method.
The Experimental Trans-Contextualisation (ExTC) in TSD The theory-analytical technique of Experimental Trans-Contextualisation (ExTC) presents the methodical basis for the procedure in TSD.
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“The formal process of an Experimental Trans-Contextualisation act, which can also be described as circular motion of reflexive gain of knowledge and consists of two parts of motions (1./2.), derives from the constructive-realistic idea of ‘Strangification’ […].” (Greiner 2012, 169) The idea of Strangification is based on the thought that who is kept only in one’s own structures of thinking and acting, has limited points of view on the personal structures and processes. It is necessary to have a certain distance in order to widen the perspective and to be able to look at one’s own system “from outside”. This distance will be achieved by removing one part of the structure of scientific approaches from its genuine context and integration in the strange frame (conditions) to have the possibility to observe it from the outside. “Only when familiarities are made strange only then it can be gazed at and in consequence also can be potentially changed”. The Experimental Trans- Contextualisation (ExTC) can also be described as a “standardised tactic of reflexive scientific shift of perspective”. (Greiner 2012, 30) The formal procedure of ExTC processes consists of two part motions: “In the process of ‘Strangification Movement’ (1.), which is described as the act of perspective shift; at first a special term figure or statement (Transponat) is taken from its own therapy system (Original context) and is put into a heteromorphous therapy system (Strangification context). Considering it practically the first section of motion divides itself in an extraction and implantation sub-process, though in the process of extraction there is an attempt to take the Transponat from its Original context to be able to transfer it into a different structure of meaning. In the process of implementation this Transponat will be experimentally integrated in the strange context (Strangification context), this means an experimental attempt to incorporate and to apply it into a new context. In the ‘Adoption Movement’ (2.), the so called act of technical utilization, the relevant knowledge which was gained in the Strangification context due to hetero-contextual confrontation (irrationalities, contradictions, absurdities) can prosper for the own professional actions in therapy.” (Greiner 2012, 169-171)
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Determination of the dialogue experimental basic terms in TSD (Greiner 2012, 17 -172) Dialogue dimension (Dd): Intensity, extent or rather the area of the trans-contextual dialogue experiment. Original context (Oc): the (one’s own) therapy system, where the user of the Therapy Schools Dialogue scientifically and practically is or rather will be socialized.
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Strangification context (Sc): that heteromorphic therapy system in whose structure an Experimental Trans-Contextualisation (ExTC) shall be carried out. (Nota bene: the bigger the structural differences between two dialogue partners or rather therapy systems, the more profitable it is for ExTC!) Discourse field (Df): that thematic or rather theoretical basic field of the Original context (Oc), from which a “Transponat” (T) will be taken (e.g. anthropological, scientific-philosophical, theory of socialization, ethical, theory of sexuality, personality theory, psychopathology, the technique of the therapy etc. basic assumptions and views).
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Transponat (T): that typical term figure or characteristic statement or rather that specific system of sentences from the Original context (Oc), which should be experimentally trans-contextualised into the chosen Strangification context (Sc) (i.e. an attempt of transference, translated provisionally). In fact, each Transponat must have two different “Transponat’s Aspects” (TA); Transponat’s rule: the Transponat (T) has to show ambivalent relations to the Strangification context (Sc) (Relation of “both: kind of yes-and-kind of no”)! Apparently Matching Transponat Aspect (MTA): such an aspect of the Transponat (T), that promises high possibility of hetero-contextual integration or rather appears to have high suitability of the transference in relation to Strangification context (Sc). Apparently Mismatching Transponat Aspect (MMTA): that aspect of Transponat (T), whose possibility of heterocontextual integration is more questionable or rather the suitability of transference in relation to Strangification context (Sc) will be strongly doubted.
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The methodological structure of Experimental Trans-Contextualisation (ExTC) in Therapy Schools Dialogue in details (Greiner 2012, 172-183) I. Dialogue Preparation: the dialogue foundation based on literature – selection and limitation of the relevant text materials for the analysis This procedural main point I divides itself in three sub items (I.1/I.2/I.3). I. 1. Determination of Dialogue dimension (Dd) for the textual analytical investigation I. 2. Dialogue relevant data basis from the Original context (Oc): For the planned dialogue the dedicated Discourse field (Df) 1 of the one's own therapy system A (Oc) is presented (presentation of the text via literature research). Correspondingly all other possible Discourse fields (2, 3, 4 etc.) are presented, too.
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I. 3. Dialogue relevant data base from the Strangification context (Sc): Relevant discourse field (Df) 1 from a different therapy system B (Sc) will be presented (presentation of the text via literature research). All other possible further Discourse fields (2, 3, 4 etc.) are presented as well.
II. Dialogue Operation: five dialogue operative stages and dialogue summary This procedural main item II divides itself into five sub-items (II.1–II.5), some detailed steps as well as a summarizing sub-item (II.6) II. 1. Selection and definition of Transponat (T) In the first dialogue operative stage the Transponat (T) which has an (apparently) Matching Transponat Aspect (MTA) and an (apparently) Mismatching Transponat Aspect (MMTA) will be presented.
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II. 2. Short Explication of the Matching Transponat Aspect (MTA) in its Original context In the second dialogue operational stage the use and the application context of the MTA in Original context (Oc) is presented briefly. II. 3. Translation and integration The third dialogue operative stage divides itself into three procedural detailed steps. (II.3.1/II.3.2/II.3.3). II. 3.1. Determination and presentation of the Hetero-contextual Interconnection for MTA In the first detailed step of the third stage it is searched for the Hetero-contextual Interconnection, which has to be presented thereafter. This is a chance for integration and a corresponding link or connection possibility respectively for the MTA in Strangification context (Sc).
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II. 3.2. Short explication of the Hetero-contextual Interconnection in its Original context In the second detailed step of the third stage the use and the application context of the discovered Hetero-contextual Interconnection MTA in Strangification context (Sc) is presented briefly. II. 3. 3 Demonstration of intersection in Discourse field In the third detailed step of the third stage the presentation of discovered numbers of opinion, perception and understanding elements, which both dialogue partners or rather therapy systems (Oc and Sc) have in common within the Discourse field (Df), is carried out. II. 4. Critical testing of hetero-contextual integration attempt Just like the third stage the fourth stage of Dialogue operation divides itself into three procedural detailed steps. (II.4.1/II.4.2/II.4.3).
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II. 4.1. Focus on the (apparently) Mismatching Transponat Aspect (MMTA) of the Transponat: In the first detailed step of the fourth stage the attention is directed now to the MMTA in its Original context. II. 4.2. Verification of hetero-contextual transfer suitability in the light of MMTA In the second detailed step of the fourth stage the critical testing at a certain place must point out a “Contradiction”. It is a question of the “location of contradiction” or rather of the point of absurdity in the Strangification context (Sc), in which the translation attempt definitely failed. Under the title Presentation of Extracted Contradiction this point of absurdity (Location of contradiction) is finally disclosed. II. 4.3. Hetero-contextual transfer failure of the Contradiction
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In the third detailed step of the fourth stage for reasons of plausibility or rather for the purpose of a better confirmability the failure of integration is discussed briefly in a summarised proving argumentation. II. 5. Reflection profit In the fifth and the last stage of Dialogue operation the serious and intensive debate with the Contradict, which let the hetero-contextual integration attempt fail, finally creates insights in the implicit structure of conditions and commitment, that is within unarticulated pre-condition structures, which have to form the basis of the Transponat (T) in the Original context (Oc) (specific logic of the context), in order not to result in absurdities and inconsistency in contrast to the Strangification context (Sc). Reflexive findings of this kind have an inspiring and creativity-promoting effect and potentially can stimulate theoretical, methodological and process-related modifications in the one’s own therapy system (Original context/Oc).
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II. 6. Summary of dialogue results In this summarized sub-item of the second procedural main item three single steps are recapitulated (II.6.1./II.6.2./II.6.3.): the result of dialogue confrontation between therapy system A (Oc) and therapy system B (Sc) in the Discourse field (Df) 1 of Transponat (T) × in accordance with the applied data base. II. 6.1. Intersection relevant to Transponat in Discourse field (Df) 1 in accordance with applied data base II. 6.2. Difference relevant to Transponat in Discourse field (Df) 1 in accordance with applied data base II. 6.3. Reflection profit relevant to Transponat for therapy system A (Oc)
III. Dialogue Evaluation: personal evaluation of the relevance of the dialogue results for one’s own therapy practice
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The last procedural main item III offers space for a comprehensive individual statement via reasonable (based on practical experience and literature-support) argumentation.
3.2 Methodological specifics of Therapy Schools Reflection (TSR) by Psycho-Text-Puzzle (P-T-P) The creativity-focused Psycho-Text-Puzzle (P-T-P) (Greiner et al. 2012) is another research tool of Experimental Hermeneutics in Psychotherapy Science at SFU Vienna which is divided into five different stages: Presentation (1), Selection (2), Substitution (3), Transformation (4), and Conclusion (5). A brief explanation of each stage is going to be given before illustrating the process of the whole Psycho-Text-Puzzle gameplay.
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Stage 1: Presentation Choose a SP-Text (scientific psychotherapeutic) and a NS-Text (non-scientific). (a) Scientific psychotherapeutic text/SP-Text of the psychotherapeutic modality the P-T-P-Player belongs to (i.e. S. Freud’s Theory of Personality, A. Adler’s Compensation Theory, E. Bernes Transactional Analysis etc.). (b) Non-scientific text/NS-Text (i.e. fairytale, story, poem, songs, as well as fantasy, science-fiction, mystery, urban-legend, comics, but also possible are advertisement-brochures, instruction manuals, city guides and recipes). Stage 2: Selection Select specific text elements (relevant structural parts and segments): (a) Scientific and theoretical-psychotherapeutic elements/SP-Elements. (b) Non-scientific text elements/NS-Elements (fictional narrative, everyday language, administrative language, etc.)
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Stage 3: Substitution Substitute the non-scientific elements: the SP-Elements replace the NS-Elements. This exchange process can be done systematically using theory-based associations on the premises of “What is useful? What is natural?” It can, however, be done theory-independent, by just freely juggling around the terms. In many cases, throughout the substitution process, it will turn out that one may need more SP-Elements and/or NS-Elements for the progression in this stage. A subsequent selection is almost inevitable and, of course, legitimate. Generally the substitution process only works adequately when it is carried out with serious intentions which ultimately forms a logical or coherent “New Text”/”Transformation Text”. Stage 4: Transformation Insert the substituted text elements into the non-scientific text structure: the SP-Elements (theoretical terms) are integrated into the NS-Text (fictional narrative, song lyrics, operating manuals, etc.) from which a Transformation Text (New Text) is developed.
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Stage 5: Conclusion The Psycho-Text-Puzzle aims to, through the fun-like strategy of original remodeling and bizarre recombining, evoke innovative perspectives and inspirational impulses that could affect productivity in the scientific approach of psychotherapeutics. In the conclusion stage the questions of “to what extent” and “in what manner was the intended target achieved” are brought up. A four-staged approach should answer these questions. (5.1) Contemplation into the Transformation Text In the process of reading the newly created text one should allow themselves to, firstly, look at the transformed text and feel what ideas, images or scenes may arise. (5.2) Concentration on the Exotic-Factors
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A focus is laid upon the more unusual and exotic segments of the text. These are called the Exotic-Pointes (EP) and select considering the theory-specific psychotherapeutic concepts any bizarre, grotesque, or obscure parts in the Transformation Text. (5.3) Deduction of the Provocates Which obscure and unusual perspectives are made aware when looking at the Exotic-Pointes? In this stage, one should confront the psychotherapeutic theory with the obscure and unusual segments. The outcome of this process is going to be a series of sentences or ideas that are the “Provocates”. (5.4) Discussion of the Impulse-Potential This step includes the discussion of the Provocates mentioned in the previous stages. One should discuss if a certain Provocate may give an impulse for developing new ideas in the psychotherapeutic context. Theses Impulse-Potentials should be discussed and elaborated in a scientific circle and not forgetting to protocol the discussions no matter what the end-result may be of the discussions.
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3.3 Methodological specifics of Therapy Schools Reflection (TSR) by Psycho-Picture-Process (PPP) The investigation process of the next experimental-hermeneutical analysis technique named Psycho-Picture-Process (PPP) (Greiner et al. 2013) can be divided into six process stages or analysis steps: 1) Selection, 2) Isolation, 3) Creation, 4) Interpretation, 5) Modification and 6) Confrontation. Each step of the analysis process will be described before giving a detailed process-orientated illustration of how the whole process works. Step 1: Selection First of all a certain theoretical correlation (“Theoretical Piece”/“Theoriestück”) of the psychotherapeutic modality the PPP-analyst comes from has to be chosen. With this the PPP can be extensively edited and critically reflected upon. Step 2: Isolation
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From the chosen Theoretical Piece, certain “Theory-Specific Terms” (“Theoriebegriffe”) should be filtered out and isolated. These theoretical terms should be presented in form of a list. Step 3: Creation The following Creation Step is divided into two sub-categories (3a and 3b): (a) Free creation of the Psycho-Picture (PP) By using creative media (pictures, colors, collages etc.) one should now construct a “Psycho-Picture” or PP. Before going into the theory specific background interpretation the theoretical terms should be isolated in order to create a symbolic picture-story. It is important that the filtered terms in the picture can be found and seen later on.
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(b) Creating a Re-Symbolizing List After finishing the PP a “Re-Symbolization” of the symbols must be performed i.e. the freely made up central picture-elements that were symbolized should be identified as theory-specific objects and written down as a list (“Re-Symbolization List”). Step 4: Interpretation The created PP should now be looked at and interpreted by an “External Interpreter” or ExI (a person that is not a psychotherapist) and a theory-free description should be given. Under no circumstances the ExI should get insight into the Re-Symbolizing List. Like this the ExI will have a free and non-scientific approach of the picture. Step 5: Modification
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Now the PP-Creator takes the “External PP-Interpretation” and exchanges the terms. The PP-creator writes down the observations of the ExI in such a way that the central picture-elements are swapped by the school-specific theory terminology according to the Re-Symbolization List. Like this the External PP-Interpretation transforms into the “Modified PP-Interpretation”. Step 6: Confrontation The following Confrontation Step is divided into three sub-categories (6a/6b/6c): (a) Working out the convergences and divergences (absurdities) The last step involves looking at Modified PP-Interpretation and the Theoretical Piece (modality-specific theory). That’s why the first objective is to seek out the potential convergences and divergences that formulate when comparing the Modified PP-Interpretation and the specific theory. For a systematic approach in the process it is useful to break down the relevant interpretation extract into small units or sentences.
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(b) Discussing the convergences and divergences The second step involves the critical-analytical discussion of the identified divergences and convergences. This confrontation and discussion of the absurdities and commonalities should eventually lead to an insight that can merge to an understanding and further insight into the school-specific thoughts and actions. To be able to approach these insights one has to conduct a “Convergence Analysis” and a “Divergence Analysis”. (c) Conclusion for one’s own therapy praxis
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From this newly gained experimental-hermeneutic realizations or new formed knowledge one is able to reflect upon the uses and the extent this new knowledge is useful in one’s own psychotherapeutic praxis.
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Little Glossary: Original Terminology in German Language Sigmund Freud University Vienna = Sigmund-Freud-Privatuniversität Wien/Paris/Berlin (SFU) Psychotherapy Science = Psychotherapiewissenschaft (PTW) Constructive Realism = Konstruktiver Realismus (CR) Strangification = Verfremdung Micro Worlds = Mikrowelten Experimental Hermeneutics = Experimentalhermeneutik Transfermeneutic Psychotherapy Science = Transfermeneutische Psychotherapiewissenschaft Therapy Schools Dialogue = Therapieschulendialog (TSD) Experimental Trans-Contextualisation = Experimentelle Trans-Kontextualisation (ExTK) Therapy Schools Reflection = Therapieschulenreflexion (TSR) Psycho-Text-Puzzle = Psycho-Text-Puzzle (P-T-P) Psycho-Picture-Process = Psycho-Bild-Prozess (PBP)
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Reference 1
Greiner, Kurt (2005): Therapie der Wissenschaft. Eine Einführung in die Methodik des Konstruktiven Realismus. Band 2 der Schriftenreihe Culture and Knowledge (Ed. Friedrich G. Wallner), Peter Lang Verlag, Frankfurt a. M. 2 Greiner, Kurt (2007): Psychoanalytik als Wissenschaft des 21. Jahrhunderts. Ein konstruktivistischer Blick auf Struktur und Reflexionspotential einer polymorphen Kontextualisations-Technik. Band 6 der Schriftenreihe Culture and Knowledge (Ed. Friedrich G. Wallner), Peter Lang Verlag, Frankfurt a. M. 3 Greiner, Kurt (2008): Intra-psychotherapeutische Trans-Kontextualisation. Konturen einer innovativen Psychotherapieforschung im Zeichen des epistemologischen Dialogs (S. 121–127) In: Psychotherapie Forum, Vol. 16/No. 3, Springer-Verlag, Wien–New York. 4 Greiner, Kurt (2011): Integrationsprogramm Therapieschulendialog (TSD). Entwicklung einer textanalytischen Grundlagenforschung in der Psychotherapiewissenschaft. Peter Lang, Frankfurt a. M.
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5
Greiner, Kurt (2012): Standardisierter Therapieschulendialog (TSD). Therapieschulen-interdisziplinäre Grundlagenforschung an der Sigmund-Freud-Privatuniversität Wien/Paris (SFU). SFU-Habilitationsschrift. Sigmund-Freud-Privatuniversitäts-Verlag, Wien. 6 Greiner, Kurt (2013): Methodenfahrplan Inter-Therapeutik (ITK). Transfermeneutische Psychotherapiewissenschaft an der SFU Wien. Sigmund-Freud-Privatuniversitäts-Verlag, Wien. 7 Greiner, Kurt; Jandl, Martin J.; Paschinger, Otto (Hrsg.) (2009): Programmatik und Praxis im Therapieschulendialog (TSD). Erste Beiträge zur dialogexperimentellen Theorien-Integration in der Psychotherapiewissenschaft. Sigmund Freud Privatuniversitäts-Verlag, Wien. 8 Greiner, Kurt; Jandl, Martin J.; Wallner, Friedrich G. (Hrsg.) (2010): Aus dem Umfeld des Konstruktiven Realismus. Studien zu Psychotherapiewissenschaft, Neurokritik und Philosophie. Peter Lang Verlag, Frankfurt a. M. 9 Greiner, Kurt; Jandl, Martin J. (2012): Das Psycho-Text-Puzzle und andere Beiträge zu Psychotherapiewissenschaft und Philosophie. Sigmund-Freud-Privatuniversitäts-Verlag, Wien. 10 Greiner, Kurt; Jandl, Martin J.; Burda, Gerhard (2013): Der Psycho-Bild-Prozess und andere Beiträge zu Psychotherapiewissenschaft und Philosophie. Sigmund-Freud-Privatuniversitäts-Verlag, Wien. 11 Peschl, Markus F. (1991): Wissen, Wirklichkeit und Handeln. (S. 1-16) In: Peschl, M. F. (Hrsg.): Formen des Konstruktivismus in Diskussion. Materialien zu den „Acht Vorlesungen über den Konstruktiven Realismus“ WUV-Verlag, Wien. 12 Slunecko, Thomas (1996): Wissenschaftstheorie und Psychotherapie. Ein konstruktiv-realistischer Dialog. WUV-Universitätsverlag, Wien. 13 Wallner, Friedrich (1992): Wissenschaft in Reflexion. Verlag Braumüller, Wien. 14 Wallner, Friedrich G. (1997): Aspekte eines Kulturwandels: Der Bedarf nach einem neuen Begriff des Wissens (S. 11-27). In: Wallner, F.; Agnese, B. (Hrsg.): Von der Einheit des Wissens zur Vielfalt der Wissensformen. Erkenntnis in Philosophie, Wissenschaft und Kunst. Braumüller Verlag, Wien. 15 Wallner, Friedrich G. (2002): Die Verwandlung der Wissenschaft. Vorlesungen zur Jahrtausendwende. Verlag Dr. Kovac, Hamburg. 16 Zitterbarth, Walter (1991): Der Erlanger Konstruktivismus in seiner Beziehung zum Konstruktiven Realismus. (S. 73-87) In Peschl, M. F. (Hrsg.): Formen des Konstruktivismus in Diskussion. Materialien zu den „Acht Vorlesungen über den Konstruktiven Realismus“ WUV-Verlag, Wien.
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Kurt Greiner and Gabriela Breindl
About the authors Kurt Greiner Univ.-Doz. DDr. phil., teaches philosophy and methodology of psychotherapy science at Sigmund Freud University Vienna (SFU Vienna/Paris/Berlin) and invented the analysis programme of Experimental Hermeneutics.
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Gabriela Breindl Mag. Ba. pth., Psychotherapy scientist and psychotherapist (Integrative Gestalttherapie) living in Lower Austria. Works out her doctoral thesis at Sigmund Freud University Vienna (SFU Vienna/Paris/Berlin).
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Chapter 4
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The Buddhist Perspective
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The Wheel of Life and Buddhist Understanding of Health Sumalee Mahanarongchai (Bangkok, Thailand, Thammasat University)
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Abstract This article aims to explore what is ultimately understood as life and health in Theravāda Buddhism. A life in Buddhism arises as psychophysical phenomena. It is the sum, or the totality, of vital life-force unified into a whole. Each of life-force is unified by twelve interweaving acts (or links) of the mind. The mind (or every of arising mind if Dhamma analysis is strictly mentioned) exists in terms of the dispositional flaring energy. With intention, the mind originates life through birth (the eleventh link), but birth is always accompanied by mental defilements found in ignorance (the first link), craving (the eighth link) and clinging (the ninth link) which are the main causes of birth. Likewise, mental defilements, especially those fundamental ones, are known as the causes of disease. Life and disease are thus very close. In the case of an ordinary person, the mind is navigating itself forward upon two possibilities; a potentiality toward life and a tendency toward illness. Heath points to the mind’s capacity in keeping a balance between these two possibilities. It involves with the serene trait of mind in prior to the state of happiness. Health can be boosted by the practice of mindfulness. Buddhist understanding of life and health can help one clearly get across the Eastern way of healing. “Health is the highest gain; contentment is the greatest wealth; trustful are the best kinsmen; Nibbāna is the highest bliss.”1
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What is life? In the widest sense, life is called to everything included in the multiple combinations and permutations of visible and invisible phenomena. It signifies what exists amid the myriad of phenomena which can be piled up from the tiniest microorganisms to the giant stars. But this definition seems too broad and easy to be misinterpreted. Some readers may think that under such definition a machine like computer must also have its own life. If so, various points of controversy will be raised. It is not my intention to tackle with this controversy in this article. I will focus mainly on my assumption that living beings have something extraordinary from non-living beings. And among living beings, human being is mostly capable of perceiving one’s own complicated life-structure. The structure of human life is cyclical, not linear. Knowing the wheel of life will lead to understanding what health is for an individual. What makes a living being different from a non-living being or an inorganic thing, according to Ikeda, is its potentiality to create and place itself in situations. No matter how capable a machine is, it cannot create all energy it requires. A machine must firstly rely on the external source of energy in starting its process. A living being, on the other hand, can gather energy with its own strength and effort. This energy is then consumed for its own movements. Strength and intelligence are thereby inherent in what one calls “life.”2 In other words, life means something which is at once the creator and the created. Furthermore, living beings are essentially unique because not merely a concrete life can be created out of one’s movement through strength and intelligence, each of tiny cells can kindle a subtle life of its own in terms of vital life-force. Each unit of vital life-force works with one another to produce a larger unified whole. This fact can be clearly detected by scientific equipments and endorsed by religious means. Up to now, the presence of countless millions of wave generating microcosms in the cells of human bodies has already been discovered by scientists. In addition, machines which can measure and show in photographs thousands of electrical waves of thought discharged every second by an active brain have also been constructed.3 It seems that the above examples are demonstrating the movement of vital life-force as wave-like flow of energy. Such movement is spontaneous. When the required conditions are fulfilled, a life is first ignited as energy. All forms, subtle or crude, come later by the combination of the matter in association with the mind. If one’s life starts by vital life-force flaring up energy from moment to 266
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The Wheel of Life and Buddhist Understanding of Health
moment, one’s mind must be the most fundamental but complex form of this evolution. But can one prove these arguments by referring back to Buddhist traditional scriptures or commentaries? In Theravāda tradition, the elaboration of vital life-force is not clearly found. Nevertheless, a Pāli term “jīvitindriya” is used to identify life-faculty or life-vitality.4 This term in the broad meaning indicates the process of mind- matter association. It points to a conglomeration of five psychophysical components which is well known in Buddhism as five aggregates (Pāli: pañca-khandha). Five aggregates are conducive to life. A conglomeration of five psychophysical components is achieved under the act of what Buddhists entitle “the mind” (Pāli: citta). In addition, life-vitality in the narrow meaning is a rudimentary mental concomitant (Pāli: cetasika). This mental concomitant is always found with each arising mind. In short, within the mind life-vitality is always there. It is very difficult to define the mind. In the case of human beings, the mind is called to the dispositional, or intentional, innate energy. It is one of four ultimate truths declared by Abhidhammists.5 As elucidated in the commentary of Pāli canon the mind is the common denominator for all mental operations. In general the term “citta” admits of various qualifications and distinctions according to the cluster of factors as well as the resultants. The mind is both the resultant of many factors and the determining element in one’s life. It also moulds one’s actions and ideas down to the minutest details. It is obvious that there is not only mind valid for all human beings. Rather, there are a number of minds in accordance with the group-patterning factors or events.6 Guenther calls the mind [the dispositional] attitude.7 The mind (in general connotation) or every arising mind (in Abhidhammic connotation) builds up its own continuity by the way of apperceptive process. As a resultant it is built up by activities and affectivities. But it is also capable of producing a variety of operations or resultants (or effects). The mind does never arise as something simple. It exists in mutual connection with many of mental factors, preceding and accompanying them. Mental factors are known in Pāli as “cetasikas” which are mental concomitants or those which essentially arise with the mind. In other words, the mind always arises in simultaneity with some group-patterning factors. Some factors like life-vitality, feeling, perception and volition will always accompany every rising mind.8 The importance of the mind, whether it tends to become involved in the cycle of life (saṁsāra), or tends to find its fulfillment in the state of liberation (nibbāna), is the key to Buddhist philosophy and psychology.9
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The significance of the mind cannot be undermined. It is the center of one’s overall consciousness. The mind encompasses cognition in the most comprehensive sense. It means mental object, or presentation, inasmuch as a process of connecting the last impression which keeps arising in consciousness with the preceding ones. The mind is a state10 of coordinating, relating and synthesizing. Furthermore, it has the property of initiative action.11 The mind, like the matter or Rūpa, exists in terms of momentary being. A mind arises when another dissolves. The existence of the mind is radiant, swift and extremely subtle. No one can catch it because it is always wandering in flit.12 The Buddha says thus:
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It were better, brethren, if the untaught manyfolk approached this body, child of the four great elements, as the self rather than the mind. Why so? Seen is it, brethren, how this body, child of the four great elements, persists for a year, persists for two years, persists for three, four, five, ten, twenty, thirty years, persists for forty, for fifty years, persists for a hundred years and even longer. But this, brethren, that we call thought, that we call mind, that we call consciousness, that arises as one thing, ceases as another, whether by night or by day.13
From the above quotation, one is acknowledged that the mind exists in terms of flaring energy. One arises after another dissolves. That which transmitted from one to another is kammic seed or impression. The movement continues in flux as flows of consciousness. The mind-flow originates life by means of its vital energy. The capacity of life-preservation (jīvitindriya) is always inherent within the mind. By this understanding, the ultimate explanation of every arising mind in Theravāda tradition is compatible to the declaration of vital life-force in some Mahāyāna schools. The existence of one is analogous to the existence of another. It is now plausible to say that in both traditions life is the sum of vital life-force unified into a whole. Theravādins endorse that life is originated under the supervision of the mind as the dispositional flaring energy. According to Buddhist philosophy, there will never be a creation from the external source of power, let alone the belief in superstition. The physical body and the brain are merely the manifestation of life-force. Each organ expresses life-force in a visible, complicated and changeable form. A change in every moment of life reflects vital life-force arising and dissolving in continuum. Vital life-force is the essence of one’s body. It integrates all physical parts into a whole. Ikeda remarks that:
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The life-force expresses itself in living beings. It embodies the innate intelligence of the human body. But in order for this life-force, which is the essence of life, to operate, it must gather physical matter from the cosmos and manifest itself in a living body. The body is, then, the place where the life-force expresses itself in its earthly phenomenal form.14
What is the implication of these elaborations? At least some intriguing assumptions in relation to health can be drawn as a philosophy of life. Those are significant for one’s further investigation. First, it is quite common among Eastern philosophy like Taoism, Hinduism and Buddhism to approve the fundamental fact of life in terms of vital life-force. The body is not just a conglomerate of physical elements. Within it there lies a well-ordered and rhythmical life-complex which is creating and recreating itself. Each tiny cell in the body is a particle of life. It has its own intrinsic nature and operates in harmony with other cells under the supervision of some ultimate reality like Tao (Taoism), the One (Hinduism) or the mind (Buddhism). Though abstruse, vital life-force symbolizes self-regenerative capacity found in every tiny cell combined into a life. The capacity of self-regeneration is always dynamic. It is enormously effective to one’s own well-being if this capacity is rightly motivated. This means that a key to health lies hidden in the flow of vital life-force. Second, both Mahāyānists and Theravādins hold a common belief in some innate force circulating within one’s body. Based on this belief, there is a galaxy of forces forming an entity which becomes the substance of one’s inner life. It is understood as the spiritual law of life.15 The inner power is incessantly manifesting itself in every movement of one’s physical body, creating life as one is. And it is quite clear that in Theravāda tradition this so-called inner power is entitled the mind. There is thus no sharp distinction between the spiritual and the physical aspect of life, nor is the mind isolated from the body. In other words, no dualism between the mind and the matter that form a body is found in the practical sense. Both aspects interconnect and shape a life in subjection to vital life-force. Therefore, another key to health may be lost unless the mutual dependence between the mind and the matter is understood. Third, even though vital life-force is induced within each cell, life-force of one cell is inseparably bound with life-force of other cells. The stream of overall life-force nourishes not only the body, but also the universe as a whole. A defective flow of life-force can bring a negative cause, or effect, to the rest like waste water can contaminate the entire flow of river. Many of physical pains may result
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from mental illnesses and vice versa. Likewise, a variety of mental illnesses is diagnosed in relation to situational imbalance or environmental pollution. Not only the mind and the body cannot be separated, but an individual mind does never exist independently from the integral flow of universal consciousness. But this argument is strongly claimed in Mahāyāna than in Theravāda tradition. From these assumptions one learns that a life and a body are mere compound. The ultimate fact is vital life-force. Nurtured by life-vitality which is always with it, every arising mind must be understood as the dispositional flaring energy in originating life. By this definition, the mind can never be the dualistic aspect of the body because the body is derivation, but the mind is primordial. Neither the theory of mind-body isolation nor the view of individual life-force in separation from the flow of universal force has been taught in Buddhism. The existence of vital life-force, or even the mind, depends on conditions. Despite each life-force bears its own intrinsic nature, no self-nature is retained as a sign of individuality above all conditions.16 Nothing is empirically found independent from the others. The teaching of mutual dependence is well enunciated by the Buddha. It is called the cycle of dependent origination (Pāli: paṭiccasamuppāda) When human being is the primary concern this teaching will be recognized as the wheel of life (Pāli: saṁsāracakka/ bhavacakka). The wheel of existence, rebirth, or becoming, is sometimes summoned to the wheel of life.17
The Wheel of Life As one knows, a life begins with birth and goes through old age, sickness, all sorts of occasional discomforts, and then ends with death, each of which is an item of suffering. In other words, a life stands between birth and death.18 To understand a life encourages one to understand how birth takes place. The process of life has been explained as a flow moving continuously in cycle. The body is nothing but the sum of the matter associated with the mind. It is a compound of psychophysical constituents. Or it is the totality of psychophysical phenomena. Neither an illusion nor the fact it is. The fact is vital life-force in process. But how can one understand the process, or the flow, of vital life-force? How can the flow of life-force be unified into a whole? The answer of these questions lies in the investigation of dependent origination. To understand the process of vital life-force, one must first understand various acts of the mind which are portrayed as twelve interweaving links in the 270
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The Wheel of Life and Buddhist Understanding of Health
wheel of life. Link (Pāli: nidāna) is the inseparable stage, or component, in the process of existence. There are twelve links demonstrating a chain of dependent origination. The twelve-link chain is not a linear mental progression through time or space. Rather, it is cyclical. If one link is mentioned, other links will also be simultaneously referred to. The characteristic of each link is summed up as “from the arising of this, that arises; from the ceasing of this, that ceases.”19 A formal explanation of the chain tends to start with ignorance which means the lack of knowledge. Disturbed by ignorance, the mind starts formatting itself with an intention. The intentional mind then performs the act of consciousness in six ways.20 The act of consciousness puts forth a conglomeration of the mind and the matter to which five aggregates are declared. Next, five aggregates pave a way to the rise of six sense-organs. The point upon which the interlocking of three essential components; namely a sense-organ, an act of consciousness (or a sense- consciousness) and the unknown external object takes place is known as contact. Contact starts after three essential components are ready in work. It follows the rise of six sense-organs. Conditioned by contact, feeling follows. Conditioned by feeling, craving arises. Conditioned by craving, clinging arises. Conditioned by clinging, becoming arises. Conditioned by becoming, birth arises. Conditioned by birth, decay and death arise along with a bundle of regular and occasional suffering. Filled with suffering, ignorance is again renovated. A wheel of life brings about another wheel of life incessantly insofar as ignorance is influential. Herein, housefather, the Ariyan disciple thus reflects: This being, that is. By the arising of this, that arises. This not being, that is not. By the ending of this, that comes to cease. That is to say: Because of ignorance, the activities; because of the activities, conscious being; because of conscious being, name-and-shape; because of name-and-shape, the six centres of sense; because of the six centres of sense, contact; because of contact, feeling; because of feeling, craving; because of craving, grasping; because of grasping, becoming; because of becoming, birth; because of birth, decay-and-death, grief, lamentation and woe, dejection and despair come into being. Thus is the arising of this whole mass of Ill. But with the waning and utter ceasing without remainder of ignorance, the ending of the activities; with the ending of the activities, the ending of conscious being; with the ending of conscious being … decay-and-death, grief, lamentation and woe, dejection and despair cease to become. Thus is the end-
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Sumalee Mahanarongchai ing of this whole mass of Ill, and this for him is the Ariyan Method well seen, well penetrated by insight.21
According to Tibetan Buddhism, the wheel of life has been artistically illustrated in metaphor.22 First of all, the entire wheel of one’s life is swallowed, or held in the claws of “Yama,” the god of death. This illustration symbolizes impermanence. Twelve links are then placed at the rim of the circle in both direct and reverse order. Each of them is expressed by a picture expediently drawn in description of its abstract meaning. The definition of each link in Theravāda tradition is shown in parallel with Tibetan illustration as follows: Link
Term-definition/explanation
Pictorial Illustration
Ignorance
the lack of knowledge kammic volition/ the intentional will mental predisposition
a blind man with a stick. a potter with wheel and pots.
Consciousness
the mind-act of consciousness in six ways
Name & Form
the five aggregates
a monkey with flower is climbing a tree. a man in the act of being ferried across the ocean. Or a passenger is steering.
Mental
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Formation
he Six SenseOrgans
Contact
Feeling/ Sensation Craving
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the eyes, the ears, the nose, the tongue, the body and the conscious mind the interlocking of a sense-organ, a mind-act of consciousness and an unknown external object pleasant, unpleasant, indifferent feeling the desire to have, to be, not to be
an empty house.
a man is kissing a woman.
a man with an arrow in his eye. a man is drinking wine. Or a woman is offering a drink to a seated man.
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The Wheel of Life and Buddhist Understanding of Health
Clinging Becoming
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Birth Decay and Death
the attachment to sensual pleasure, to views, to rituals, to the enduring self the kammic process leading to a being the emergence of a being the dissolution of a being
a man is gathering fruits from a tree. a married woman. Or a woman with a child. parents and children. a man is carrying a corpse to the cemetery.
At the center of the wheel, three fundamental defilements rooted in one’s existence; greed, hatred and delusion, are illustrated. Greed (or passion) is symbolized by a cock (or a dove.) Hatred is symbolized by a snake. Delusion is symbolized by a pig. These three basic defilements are silently shaping one’s ignorance, navigating one’s desire, and maturing one’s attachment. Birth and a physical body are visible productions originated out of them. It is interesting to know how twelve interweaving links cause the process of life-force. When the dispositional flaring energy (or the mind) is tainted by fundamental defilements, it starts projecting itself and the world by the way it likes, not by the way things are. Feeling (the seventh link) pays a crucial role in life-inclination. The mind arouses a desire to become something and clings vehemently to such desire. Birth (the eleventh link) arises from craving (the eighth link). Meanwhile, craving is driven by ignorance. It is the fuel that causes birth in subjection to kammic force. Birth will occur incessantly insofar as the fuel is still powerful. The Buddha says thus: ‘At the time when a flame, Vaccha, flung by the wind goes a very long way, I declare that flame to be supported by the wind. At that time, Vaccha, the wind is its fuel.’… ‘At the time, Vaccha, when a being lays aside this body and rises up again in another body, for that I declare craving to be the fuel. Indeed, Vaccha, craving is on that occasion the fuel.’23
To reiterate, birth is the production of ignorance, craving and clinging. All of these signify the basic acts of one’s contaminated mind. These links exist and move in terms of kammic force.24 When the force is full-fledged, these acts of mind will bind the mind itself with the matter and shape a suitable form of life by birth. Birth is then the appearance of five aggregates in a situation. It is also
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the acquisition of sense-spheres by this or that being in this or that class of beings.25 Birth is the stage to which becoming (Pāli: bhava) is consolidated into a perceivable being (Pāli: jāti). It symbolizes the conscious mind shaping itself onto a new environment. In other words, it shows five aggregates when arise in a new life-cycle continuum. When there is birth, life is there. But Buddhists do not restrict the explanation of life merely at the visible organic and human beings. Life in Buddhism encompasses vital life-force of all lower and higher planes. Divine beings, demons, monsters and worldly spirits are all included in the cycle of life. But it is not my intention to discuss them here. My focus is only at the organic lives and human beings. The emergence of a concrete life can be traced back to the process of twelve interweaving acts of each arising mind. As the dispositional supervising energy, the mind creates itself through its various acts and is created by them. If a life is the sum of vital life-force unified into a whole, and if the process of unifying life-force into a whole through birth is performed by twelve interweaving acts of the mind, what will be health and disease? How can these two concepts be ultimately understood? And what benefit will one get from this investigation? A remarkable fact is discovered from the investigation of the wheel of life in relation to health and disease. It is the significance of mental defilements, especially those fundamental ones. Mental defilements covertly instigate the mind to perform its various acts or functions in originating birth and life. Starting with the lack of knowledge, the mind bifurcates itself, compiles name and form into five aggregates, feels and craves to be, and then gives birth to a form of life. Mental defilements contaminate every of flaring mind. But through such contamination, the process of life is also invoked. But mental defilements are viewed as the cause of mental and physical illness. This hints that the mind of an ordinary person, tainted as usual, always contains a possibility of illness. The mind of an ordinary person is weak by nature. It is weak because it must bear the source of illness all the time. In other words, mental defilements enfeeble one’s mind from moment to moment. It is thus not surprising why in a great post-commentary of Abhidhamma, Abhidhammattha-Sangaha, it is noted that apart from food and seasonal phenomena, the mind and kammic force are main conditions to the appearance of the compound body, thus directly affect one’s health and illness.26 The tendency toward
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illness is thus the mind’s facticity (or the inevitable condition). But life is engendered by this facticity. Understanding this facticity is another key to health.
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Health and Its Significance toward Life Up to now, some important facts which are also my assumptions have been laid down. All of them are compulsive to Buddhist understanding of health. Let me first group them together for summarization. (1) The dualistic mind-body isolation has never been declared in Buddhism. The reason is that each belongs in its own level. The body is compound (or derivative). By contrast, the mind is ultimate (or primordial). (2) In the ultimate sense an organic life exists in terms of vital life-force and every arising mind exists in terms of the dispositional flaring energy. The mind’s disposition, intention, or volitional will, navigates the wheel of life. The cyclical process of twelve links unifies the flow of vital life-force into a whole. A concrete life is fully established by birth. A life is thus the sum of vital life-force unified into a whole. The unifying process is done by twelve interweaving mental links. (3) In the wheel of life of an ordinary person, there is always a tendency toward illness inherent within the mind. Mental defilements lead a common mind to create a life with its own strength. Yet, they simultaneously weaken the mind by reducing its capacity to shine. Existence of a life is therefore along with its own facticity. How can these assumptions pave a way to understand health? So far in common sense health is roughly defined as the state of happiness (Pāli: sukhabhāva). The term points to the absence of any traceable disease. Folk Buddhists interpret the state of happiness as the state of having a fit and strong body. If one wishes to be healthy, one must keep one’s body fit, firm and far from disease. Health is by this interpretation involves merely with the physical body. The mental dimension is overlooked. Food, exercise and breathing yoga are taken into account as the means to gain the physical health. On the contrary, a lot of Buddhists, mostly devout and learned, consider health as the state of final liberation. Health amounts to final emancipation (nibbāna) in which not only all kinds of disease, but the source of them, are entirely absent.27 This means that no mental defilement is allowed in one’s healthy mind by this interpretation. But if so, health can no longer be the state
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Sumalee Mahanarongchai
of happiness attainable by ordinary people. It will be reserved for few liberated persons only. This interpretation, though sublimed and mind-concerned, is too idealistic. It is not effective in a practical sense. To ask what should be the right understanding of health, three above assumptions may help one find out the middle way. If the ultimate fact of a life is vital life-force arising and dissolving in connection with other vital life-force, if the existence of every arising mind depends on conditions, and if all acts of the mind are intertwined, this means that nothing substantial is found possible. If so, health must be understood in a non-substantial basis. It is not a teaching laid against disease. It is a teaching which aims to understand disease. There is no dualism between health and disease. When disease is rightly understood and used, health is achieved. The concept of health is thus developed in proximity, not in opposition, to the concept of disease. In order to understand health, disease must not be thought of with resentment as something eccentric and distorted from the mind and the body. Rather, it is that which its source of origination lies dormant in one’s mind. Any attempt to eradicate disease, or make disease completely absent from the mind, may be an endeavor to stop the process of life unknowingly. Disease is a phenomenon apparent from the mind’s tendency toward illness in the meanwhile a life is originated from the mind’s potentiality. The capacity to balance these two opposite possibilities is health. Health is thus the capacity to keep all vital life-force in a smooth flow by living wisely with mental defilements. Following Buddhist perspective, happiness is a state of flourishing that arises from mental balance from which an insight into the nature of reality, or the wheel of life, is derived. It arises from the mind which abides in the state of equilibrium. Also, it entails a lucid awareness of the true nature of reality free from conceptualization. By training in emotional balance or mindfulness, one can learn to be happy by distinguishing between the way things are and the conceptual superimpositions one projects upon them.28 Happiness in this sense is not sensual pleasure because an experience of sensual pleasure is contingent upon specific items, places, times and circumstances. It can easily change into a neutral or an unpleasant feeling. For a quality to be grouped in the Buddhist category of happiness, it must include a deep sense of well-being, a propensity toward compassion, a reduction of vulnerability to circumstances, or recognition of the interconnectedness with people and other living beings within one’s environment. So, happiness is activated by a trait of one’s mind. Or the state of happiness follows the balanced 276
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The Wheel of Life and Buddhist Understanding of Health
trait of one’s mind. It is achieved through the mind’s dispositional quality that permeates all experiences and behaviors in balance.29 In other words, happiness implies the stable trait of one’s mind which is fully aware of its own current conditions. By cultivating in mindfulness, the alert mind will be skillful in facing a circumstance with an adjusting feeling. “Skillful” (Pāli: kusala) is an adjective used to explain health as the stable trait of one’s mind.30 The term entails the wholesome, faultless, or moral state of the mind which is productive to happy results. These mental qualities can bring about one’s good health.31 The mind, when settled in the wholesome root, will be skillful. More and more skillful the mind is, more and more healthy it will be. Four positive qualities are then prescribed as the synonyms of the wholesome and skillful trait of the mind.32 These are the innate properties required for a healthy condition of one’s life. (1) Absent of disease (Pāli: arogaya) (2) Pure or lucid (Pāli: anavajja) (3) Wise or illuminating (Pāli: kosalasambhūta) (4) Happy or satisfied (Pāli: sukhavipāka) It needs a little clarification here to the absence of disease. The absence of disease as a balanced trait of mind needs not mean the extermination of disease or the source of it – mental defilements – from one’s mind. Rather, it foreshadows the mind with its capacity to be faultless from them. If disease is none but the appearance of the mind’s negative but necessary tendency toward illness at birth, it is completely absurd to eradicate it. The absence of disease means only the serene trait of the mind whereas any of mental defilements can no longer agitate the mind at that particular time, leaving behind the tendency. As one has seen, the understanding of health in Buddhism is obviously related to the mind, not the body. The lucid, wise and relaxing mind devoid of mental diseases like temperament, fatigue or melancholia can demonstrate a healthy life because these mental qualities can arouse the capacity of self-regeneration to the flow of vital life-force. If one’s life is the sum of vital life-force, health will be the capacity of each unit of life-force in regenerating itself amid the tendency toward illness. These positive qualities can nurture health in the meanwhile health is promoting life. To understand what health means in the ultimate sense, one learns that health is a teaching aimed to revitalize every of arising mind as the dispositional flaring energy. Health reflects the mind’s capacity to keep balance between two possibilities; a potentiality toward life and a tendency toward illness. To maintain
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Sumalee Mahanarongchai
this capacity, the Buddha offers a doctrine known as “Foundations of mindfulness” (Pāli: satipatthāna) for monks or laymen to concentrate on their minds in the current situation. Four contemplations are laid as the alternatives for individual proneness.33 Those are: (1) Contemplation of the body or mindfulness with regard to the body (Pāli: kāyānupassanā) (2) Contemplation of feelings or mindfulness with regard to feelings (Pāli: vedanānupassanā) (3) Contemplation of the mind or mindfulness with regard to thoughts (Pali: cittānupassanā) (4) Contemplation of mind-objects or mindfulness with regard to ideas (Pali: dhammānupassanā) In fact, there are various courses of mindfulness taught in most of Buddhist communities. The practice of mindfulness is very effective in prevention of disease. But if a disease is already incipient, mindfulness will be practiced along with bodily treatment. The importance of mindfulness is well recognized by Buddhists of all traditions. If health is the mind’s capacity in keeping a balance between two innate possibilities and if disease is the apparent outcome of the mind’s tendency toward illness, one’s attitude upon health as well as disease must be radically changed. A focus on particular disease and symptom must be superseded by a concern on the person as the whole unified by each unit of vital life-force under the supervision of the conditioned dispositional flaring mind. The process of treatment must be integrative whereas the interaction between persons will be taken into consideration in treatment along with one’s situations and one’s experiences. Furthermore, medicine is not the priority of treatment comparing to the practice of mindfulness because it mostly deals with the symptom than the cause of illness. But if it is necessary for one to take medicine, what is regarded as good medicine must be that which is capable to boost the mind’s vitalized capacity. Medicine is used to revitalize self-healing energy.34 The aim of good medicine is to restore the balance, not to fight against disease. According to Buddhism, healing is not repairing because a man is not a machine and human being is not mere human resource. Healing is not just a job, but a human interactive activity. It is an activity to connect oneself with the whole world.35 It requires an understanding of one’s process of life with an endeavor to recover by one’s own capacity. The process of healing must be done in 278
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The Wheel of Life and Buddhist Understanding of Health
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the reciprocal way. It is futile to heal a person if that person is not willing to cooperate partly by trying to heal his or her own self. The most effective way of healing always involves self-awareness. But self-awareness cannot be fulfilled unless life, illness and health is rightly understood. To sum up, a life as one calls it is the totality of vital life-force. Each flow of vital life-force has been unified by twelve mental acts (or links) interweaving in terms of a cycle or a wheel. Nurtured by ignorance, craving and clinging, a life fully arises at birth. In the case of ordinary people, the process of life has always been motivated by fundamental defilements inherent within one’s mind. Except that of few liberated persons, as the dispositional flaring energy, every of arising mind originates a life out of its inescapable tainted condition. Knowing all of these is compulsive to Buddhist understanding of health. Health is the mind’s capacity in keeping a balance between its two possibilities; a potentiality toward life (existence) and a tendency toward illness (facticity). Neither it is the state of final liberation, nor is it the state of bodily strength absent of disease. Health highlights the serene trait of the mind. It is the point of equilibrium at which mental defilements cannot disturb the mind while it keeps on originating life through birth. The right understanding of health will help one realize how close health is with disease, and how significant the power of self-healing lies in any form of treatment.
References 1
Compound things signify five aggregates. For more detail please see The Dhammapada, trans. Nārada Thera, London, John Murray, 1959, pp. 56-7. 2 Daisaku Ikeda, Life: An Enigma, a Precious Jewel, trans. Charles S. Terry, New York, Kodansha International, 1982, p. 17. 3 Arthur De Silva, The Riddle of Life and Kindred Essays, Colombo, M. D. Gunasena & Co., Ltd., 1956, p. 5. 4 P. A. Payutto, Dictionary of Buddhism, Bangkok, Mahachulalongkornrajvidyalaya, 1995, pp. 189-90. (Thai language) 5 The other three ultimate truths are form (Rūpa), mental concomitants (Cetasika) and the state of liberation (Nibbāna). It is remarkable to note that life-vitality (Jīvitindriya) is classified as a fundamental mental concomitant always arising with, and accompanying, every arising mind.
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6
I quote the commentary of the first book of Abhidhamma (Atthasālinī) in the work of Herbert V. Guenther, Philosophy and Psychology in the Abhidharma, Berkeley, Shambhala, 1974, p. 12. 7 Ibid. 8 P. A. Payutto, Dictionary of Buddhism, pp. 325-6. 9 Herbert V. Guenther, Philosophy and Psychology in the Abhidharma, pp. 13-5. 10 What is termed a state in the Buddhist ultimate sense is decided by its general characteristic of bearing its own intrinsic nature. But in accepting intrinsic nature it does not mean that in Buddhism any of self-nature, an enduring substance, or a thought upon one’s own individuality, is promoted. For detail please see The Expositor (Atthasālinī), trans. Pe Maung Tin with Mrs. Rhys Davids, London, the Pali Text Society, 1976, p. 52. 11 Psychological Ethics (Dhammasanganī), trans. Caroline A. F. Rhys Davids, Oxford, the Pali Text Society, 1993, pp. lxxxiii-iv. 12 “Cittavagga,” The Dhammapada, trans. Nārada Thera, London, John Murray, 1959, pp. 22-3. 13 The Book of the Kindred Sayings Part II, trans. Mrs. Rhys Davids, Oxford, the Pali Text Society, 1994, pp. 65-6. 14 Daisaku Ikeda, Life: An Enigma, a Precious Jewel, p. 20. 15 Ibid., p. 23. 16 Herbert V. Guenther, Philosophy and Psychology in the Abhidharma, p. 5. 17 P. A. Payutto, Dependent Origination, trans. Bruce Evans, Bangkok, Buddhadhamma Foundation, 1994, p. 33. 18 K. D. P. Wickremasinghe, “The Buddhist View of Life,” in P. N. Chopra (ed.), Contribution of Buddhism to World Civilization and Culture, Delhi, S. Chand & Company Ltd., 1983, pp. 218-21. 19 For detail please see Introduction to the Mahā-nidāna-suttanta, Dialogues of the Buddha Part II, trans. T. W. and C. A. F. Rhys Davids, Oxford, the Pali Text Society, 1989, p. 42. Also in Steve Hagen, Buddhism Plain and Simple, New York, Broadway Books, 1997, p. 154. 20 Six ways of consciousness are sometimes explained as though there are six sense-consciousnesses. Those are eye-consciousness, ear-consciousness, nose- consciousness, tongue-consciousness, body-consciousness and mind-consciousness. 21 The Book of the Gradual Sayings Vol. V, trans. F. L. Woodward, Oxford, the Pali Text Society, 1994, p. 126. 22 Edward J. Thomas, The History of Buddhist Thought, Delhi, Munshiram Manoharlal Publishers, 2004, pp. 68-70. Also in Kaveevorayan, Bhava-Cakka: Wheel of Life, Bangkok, the Buddhist Research Center, 1962, p. 52.
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23
The Book of the Kindred Sayings Part IV, trans. F. L. Woodward, Oxford, the Pali Text Society, 1993, p. 281. 24 Kammic force signifies the impression of each vital life-force after discharging its energy and dissolving. It reflects a successive flow of vital life-force governed by the mind. In the meanwhile vital life-force is self-regenerative energy, kammic force will be such energy being contaminated, accumulated and discharged from moment to moment. 25 Mahāsatipatthānasutta, Dialogues of the Buddha Part II, trans. T. W. and C. A. F. Rhys Davids, Oxford, the Pali Text Society, 1989, p. 338. 26 Four conditions to the emergence of one’s body – food, weather, the mind and kammic force – are identified in Chapter Six of Abhidhammattha Sangaha or the Manual of Abhidhamma. For detail please see Narada Mahathera, A Manual of Abhidhamma, http://buddhasociety.com/online-books/a-manual-of-abhidhamma-narada-maha-thera-10 -7 accessed on: 03/05/2013. 27 Partly because this interpretation arises from a belief that health is something in opposition to suffering while disease is viewed as a form of such suffering. 28 Paul Ekman, Richard J. Davidson, Matthieu Ricard and B. Alan Wallace, “Buddhist and Psychological Perspectives on Emotions and Well-Being,” Current Directions in Psychological Science, Vol. 14, No. 2 (Apr., 2005), pp. 59-63, http://www.jstor.org/stable/20182989, accessed on: 25/12/2012. 29 Ibid., p. 61. 30 The term “kusala” usually means healthy, wholesome or skillful. The interpretation of kusala as healthy trait of one’s mind is also found in Richard Gombrich, What the Buddha Thought, London, Equinox, 2009, p. 15. 31 The Expositor (Atthasālinī), p. 49. 32 These four positive qualities are subsumed from what has been elucidated in some commentaries like a commentary of the Chronicle of Buddhas (Buddhavamsa). Two Pāli terms are mentioned in explanation of the wise aspect of one’s mind, cheka and kosalasambhūta. These two terms are sometimes interchangeably used. ; The Clarifier of the Sweet Meaning (Madhuratthavilāsinī), trans. I. B. Horner, London, the Pali Text Society, 1978, pp. 73-4. 33 P. A. Payutto, Dictionary of Buddhism, pp. 165-6. 34 Pinit Ratanakul, “Buddhism, Health and Disease,” Eubios Journal of Asian and International Bioethics, Vol. 14 (2004), pp. 162-4, http://eubios.info/index.html, accessed on: 14/03/2013. 35 Friedrich G. Wallner, The Philosophical Foundation of a Comparison between Western Medicine and Chinese Medicine, Beijing, Higher Education Press, 2011, pp. 82-8.
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About the author
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Sumalee Mahanarongchai, Ph.D. Department of Philosophy, Faculty of Liberal Arts, Thammasat University, Bangkok, Thailand
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Thai Buddhism on Health Pataraporn Sirikanchana (Bangkok, Thailand, Thammasat University)
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1
Introduction
According to Thai historical Texts, health care and traditional medical treatment were first systematically recorded in the reign of King Narai the Great (1656 – 1688 C.E.) in the Kingdom of Ayutthaya. It should be noted that the evidence of the Thai traditional medicine, such as a stone metate and roller used for drug pounding, was found in the Dvārāvati period (1st – 10th Century C.E.). Besides, the Ramkamhaeng Stone Inscription reveals that during the reign of King Ramkamhaeng the Great, the King had a large medical plant garden established on the top of Mount Sappaya in the province of Sukhothai. According to the Inscription, monks in the Sukhothai Period (12th – 15th Century C.E.) were knowledgeable about medical plants and Thai traditional medicine which were helpful for themselves and for laypeople (Subcharoen, 1955: 13). The original medical texts which were recorded by medical scholars under the patronage of King Narai are in hand – writing on palm –leaves as well as inscription on stone silver or gold plates. The medical texts which last until today are Gambhī-mahā-jotiratana (the Scripture of the Glittering Gems of Knowledge), Gambhī – Roga –Nidāna (The Scripture of Diseases and Related Issues) and Tamra – phra – osatha – phra – Narai (The Phramacopocia of King Narai) (Ratarasarn, 1989: 29), Though Thai medical texts show medical knowledge similar to that in the Hindu Ayurveda, they have never mentioned the word “Ayurveda” in the texts. They merely refer to the world “Tikicchā” (traditional medicine) used in the Buddhist scriptures. The word “Ayurveda” may be used in the Hindu texts later around 200 C.E. (Piyachon, 1994: 15-16). Primarily, Thai medical texts promote both physical and mental health. They introduce principles of health maintenance and medical treatments. Especially, they encourage health
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protection rather than medication. Health conditions depend on life environment as well as physical and mental states of a person. It is obvious that mental stress can induce and increase susceptibility to disease and illness. A person, therefore, should always keep himself/herself in a proper condition.
2
Thai Buddhist Attitude towards Human Health
Thai Buddhism takes naturalistic attitude towards human beings and human health. This naturalistic attitude can be found in following suppositions:
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2.1 The Composite Nature of a Human Being Each human being is composed of natural elements and possesses body and mind which are governed by internal and external causes. Human body is composed of four elements, i.e. Earth, Water, Fire and Air. Earth is the solid substance of the body, e.g., bone, brain, heart, etc. Water is the fluid substance, e.g., blood, urine, etc. Fire is the energy and temperature of the body. Air is moving in a body as breathing, gas, and pressure. These four elements are natural and not created by divine beings. They arise and exist according to their causes. (Dhammapitaka 1997: 2-3). They are not eternal substances but are symbolic constituents of a body. Knowledge of four elements is explained in detail in the Buddhist Scriptures (the Tipitaka) and Hindu scriptures. These four elements in Thai Buddhist understanding are different from those in Western philosophy since they are not created by any divine power and are subject to change and destruction according to their own causes. Thus, human beings had better keep them in good condition and balance by means of a proper life style and beneficial food. The Thai Buddhist belief in the four elements can be compared to Chinese thought of Yin and Yang as mentioned by professor Lin Yang from China Academy of Chinese Medical Science, Beijing, Republic of China. Prof. Yang told the participants in the Conference that the Chinese traditionally believe in the principles and the elements of the universe called Yin and Yang. Yin stands for the feminine element expressed as night, shadow, and negative phenomena. Yang, on the other hand, is the masculine element to be seen as day, light, and positive phenomena. The ideas of Yin and Yang can be traced back to the chief scripture of Taoism, Tao – Te Ching. (Yang, 2013). Besides, the Yin-Yang phi284
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Thai Buddhism on Health
losophy works with the five elements: metal, wood, water, fire and earth to form all natural beings and to determine their conditions. Human begins are composed of the five elements and influenced by the power of Yin and Yang. When a person is sick, the traditional Chinese physician thus considers both body and mind of the patient while the western medical doctor pays attention to only the physical body. Professor Li Hongjiao also agrees with Professor Liu Yang’s presentation. She asserts that the traditional Chinese medicine encourages human beings to live in accordance with nature. If we keep our mind in peace, we may speed up our recovery from illness. It is worth noting that while the principle of Western medicine is pathology in which the treatment begins when the disease is active, the traditional Chinese medicine is preventive (Hongjiao, 2013). The principle of traditional Chinese medicine relating to human beings and nature is notably similar to the Buddhist principle.
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2.2 Human Beings are a Part of Nature In the light of the Buddhist teaching, all natural phenomena are transient. Nature is subject to change. Animals, mountains, rivers, and even the whole universe will come to an end one day. Human beings are a part of nature which is subject to the Three Characteristics of all phenomena (Ti-lakkhaṇa) : transcience (anicca), unsatisfactoriness (dukkha) and nonselfhood (anattā) and thus is not worth clinging to. A person who understands the truth of nature can accept the bad side of his/her life, e.g., sickness and physical deterioration, without being depressed. Human beings as well as other natural phenomena are composed of the four elements and are destroyed by the separation of the four elements from one another. They are neither the center nor the masters of the universe. They need to live with other natural beings according to the Law of Nature.
2.3 The Belief in the Law of Nature The Law of Nature in the Buddhist perspective includes the Law of Cause and Effect and the Law of Kamma. The Law of Cause and Effect can be taken as a scientific law in which all phenomena arise from their causes. The Law of Kamma, on the other hand, is confined to merely an ethical law which mandates that a volitional good action yields a good effect and vice versa. (Mahachu-
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lalongkorn Buddhist University, vol. 22, 1996: 577). According to the Law of Nature, the birth, living process, and death of a human being are subject to their causes. Similarly, a good health, happiness, sickness, death and so on depend on a person’s way of life and can be explained through the Law of Nature. If one eats a good food and follows a proper way of life, one will be healthy and happy. Nevertheless, birth, old-age, sickness, and death are, in the Buddha’s teachings, natural phenomena. Besides, naturally, all human beings experience more pain than happiness throughout their lives. Though a Buddhist has to face an unpleasant experience, he or she is taught to keep his/her mind in peace. One needs to understand all natural causes of one’s experiences in order to be free from both physical and mental problems.
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2.4 A Natural Phenomenon of Life Process from Birth to Death The origin of a human being is recorded in the Mahā – taṇhā – saṃkhaya – sutta, a part of the Buddhist Scriptures (the Tipitaka). Here, a baby is born by three factors: (1) The intercourse of its parents (2) The mother is in the period of menstruation (3) A certain living being ready to be born (gandhabba) (Mahachulalongkorn Buddhist University, Vol. 12, 1996: 443-444). Birth is a natural process of cause and effect without divine intervention. After having been born on earth, one is subject to suffering revealed in old-age, sickness, and death. As a Buddhist, one is taught to suffer only physically but not mentally. Through right understanding of truth and the power of wisdom, one can secure the spiritual health which, in turn, can support one’s physical health. Finally, when death comes, a Buddhist should consider it a natural experience. Buddhist teachings, therefore, do not promote suicide and euthanasia which are unnatural.
2.5 Health Care and Medical Treatment with Natural Products The Buddhist health care and medical treatment with natural products can be traced back to the time of the Buddha. The personal physician of the Buddha was Jivaka – komārabhac who found that all kinds of plants can be used as medicine. In Thailand, he is highly revered as the primary teacher of Thai traditional medicine. In order to consider health condition and treatment for illness of a patient, a medical doctor should consider a patient’s environment as well as the 286
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qualities of his/her physical Elements. For example, a disorder of the Fire Element may relate to the malfunction of digestive system which causes the disease of stomach. (Ratarasarn, 1989: 93). Besides, those who live on a high mountain are usually susceptible to diseases related to failure of the Fire Element of their body. (Vamanond and Subchareon, 1994: 6). Since the Buddhist view of health is naturalistic, drug therapy, the main treatment of Thai traditional medicine, is generally promoted. It is composed of natural products such as herbal plants and ointment from animal grease. In some cases, drugs can be used with other forms of therapy, e.g., massage, faith healing, and psychological treatment. Though, in some part of the Buddhist Scriptures, the treatment by means of surgery is mentioned, it is not a popular method of Buddhist healing in the Thai Buddhist context. Surgery is not considered naturalistic in the process of healing. (Mahachulalongkorn Buddhist University, vol. 5, 1996: 188)
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3
The Interrelationship of Mind and Body
In Thai Medicine treatments, health and illness of a patient are considered on the basis of the interrelationship of mind and body. Thai Buddhists, in general, believe that mind and body are compound entities and interrelated. Stress and deterioration of health are caused by the imbalance of the four elements as well as mental attachment to pain and suffering. An imbalance and malfunction of any of body elements can cause various symptoms and diseases such as stress, head-ach, and heart disease. Physical health may be worsen if the mind is painful. In fact, the Buddhist teachings put more emphasis on mind and assert its power over body. A patient is thus always suggested that he or she should practice meditation along with medical treatment. Apart from meditation practice, a person is also encouraged to take an optimistic view of life and cheerful spirit in order to maintain his/her good health and to speed up his/her recovery from illness. Especially, one rather needs to be in physical and mental balance than crave for happiness since being overwhelmed by happiness may be a cause of one’s illness. (Dhammapitaka, 1997: 6-10). However, it should be noted that the Buddhist principle as revealed in the Buddhist Scriptures is different from the Buddhist culture as believed and practiced by most Thai people. Though the Buddhist scriptures emphasize the use of wisdom and critical reasoning, most Buddhists still hold to faith in certain people and supernatural beings.
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4
Health Maintenance through Holistic Treatment
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In Thai medical principle, keeping oneself in good health is better than having a good medical care. Health maintenance can be attained through keeping the four body elements in balance by means of right eating and right living. For example, in Thailand it is believed that if a person has a bad digestion, s/he needs to improve his/her Fire Element in the stomach. S/he should eat hot food and “hot” vegetable such as ginger, chili, and so on. On the contrary, if s/he has a high fever which is believed to possess too much fire Element in the body, s/he should avoid eating food of high calorie, e.g., sticky rice, durian, and so on. (Ratarasarn, 1989: 261 -265) Apart from keeping the body elements in balance, a person should also keep his/her mental balance. The art of health maintenance rest on the Buddhist assumption that when the mind is strong, it can support the body through its difficulties. Moreover, it requires right thought and right practices of both medical doctors/care assistants and patients as well as a good relationship between both parties. In the Vinaya (the monastic Rules of the Buddhist Scriptures), one can find the Buddhist methods of holistic treatment. For examples, a medical doctor/care assistant should take care of both physical conditions and mental conditions of a patient. The Vinaya thus reflects the good qualities of a successful medical doctor and those of a hopeful patient as follows (Mahachulalongkorn Buddhist University, vol. 5, 1996: 239-243) A Medical Doctor’s Good Qualities 1) To be able to prepare proper medicine 2) To know the suitable food for a patient and can prepare it properly 3) To take care of a patient with loving kindness and compassion, and not with greed for more gain 4) To be willing to serve a patient without disgusting his/her excrement, etc. 5) To be able to persuade a patient to follow the suggestion and to encourage a patient to fight against his/her illness A Patient’s Good Qualities 1) 2) 288
To be ready to take things easy To be moderate in his/her life style
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3) 4) 5)
To be willing to take medicine To tell the medical doctor/care assistant the truth of his/her illness To be patient with his/her physical pain
These good qualities demand some ethical values of a medical doctor, e.g., loving kindness, compassion, and altruistic mind, as well as some ethical values of a patient, e.g., faith, patience, and obedience. The holistic treatment also requires a holistic view of nature and all natural beings. For example, human beings are a part of nature and share the truth of their existence, becoming and death with all other natural beings. According to Buddhist teachings humankind is not the center of the universe, it is under the Law of Nature and should live in accordance with the Law of Nature as a part of the whole. In addition, the holistic view of a human being implies an interconnection of body and mind that can effect each other in both good and bad conditions. The Buddhist holistic treatment reflects the circular relationship of mind and body and the understanding of a unified world in which mind and body depend on each other, though the mind takes the leading role in human happiness and suffering. The Buddhist holistic view of a human being is well supported by Professor Zhang Lishan from Beijing University for Chinese Medicine and Pharmacology, Republic of China. Prof. Lishan takes a holistic view that a human being is an organic whole living in a changing nature. Since s/he is composed of body and mind, both should be considered in a medical treatment. Traditional Chinese medicine uses a holistic therapy for a patient while the Western medicine treats only certain organs believed to cause illness. Like Buddhist medicine, traditional Chinese medicine aims at the stimulation of a patient’s own immune system in order to cope with the patient’s disease. (Lishan, 2013)
5
The Naturalistic and Holistic Methods of Buddhist Healing
In the light of Buddhist principle, if one fails to recover from one’s illness, one should keep one’s mind in good condition by means of right knowledge. The right knowledge reveals the truth of vicissitudes of life so that one can understand the present condition and accept even its worst. In addition, since Buddhists believe that a human being is naturally composed of body and mind, the method of healing should be holistic. The meaning
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Pataraporn Sirikanchana
of “holistic” refers to the circular relationship of mind and body as well as their simple interaction. For example, in the Buddhist theory of the dependent origination (paṭicca – samuppāda), physical sensation is the cause of feelings which cause the arising of desire and attachments leading human beings to the cycle of birth and death. A medical doctor and a care assistant should, therefore, be responsible for both body and mind of patients in the long run. S/he should care for not only the recovery of the patients, but also their healthy lives in the future. The doctor’s psychological support and encouragement can speed up the patients’ recovery. In Thailand, a patient’s faith to his/her healer plays an important role in the treatment. Thai Buddhist generally believe that a virtuous healer, e.g., an ascetic or a monk who gains a special mental power through meditation, also possesses a special power of healing and can transfer the power to his patients. The patients of strong faith thus successfully recover from illness. (Sirikanchana, 2012: 11) Medical practitioners/doctors and their patients need to cooperate with one another in methods of healing, e.g., traditional medicine, faith healing, meditation, and Yoga practice. Buddhist teachings and Buddhist medical practices illustrate the methodology of Thai Buddhist healing, support patients’ rights, and promote the quality of the medical profession. It is worth noting that the naturalistic attitude of Buddhists in general can be seen in the belief of the Law of Nature which, in one aspect, is the Law of Kamma. Faith in the Law of Kamma persuades all Buddhists to accept both sides of their lives, i.e., success and failure. The same medical treatment can be a success of one patient but a failure of the other according to their kamma. The Law of Kamma is the Law of Cause and Effect relating to a patient’s deed. The success of a medical treatment, therefore, does not only depend on knowledge and skill of a medical doctor but also the patient’s kamma. The Thai traditional medicine which is based on the Buddhist teachings will be more understandable and more valuable to humankind through constructive realism and strangification. Professor Koji Nakatogawa from University of Sapporo, Japan, explains that, by means of strangification, meanings of all things depend on each person’s point of view. Thus, the truth value of all phenomena depends on different circumstances. Each person can construct a model of a theory. The collection of others’ ideas can form a manifold truth. This principle of truth construction is called constructive realism. (Nakatogawa, 2013). Moreover, Andreas Schulz from Vienna University, Austria, agrees with Nakatogawa. He asserts that there is no absolute truth. Truth depends on a cultural context 290
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and can be grasped by strangification and constructive realism (Schulz, 2013). Hence, Thai traditional medicine adapts methods of healing to changing phenomena and real condition of each patient. Unlike Western medicine in which medical techniques and methods can be generalized, the Thai Buddhist medicine needs knowledge of a micro-world of human life in which everything is changing according to reality constructed by human experience.
Bibliography
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1
Dhammapitaka (P.A. Payutto), Phra, (1997). Raksa Chai Yaam Puay Khai (Taking Care of One’s Mind While Getting Ill). Bangkok; Sahadhammic Printing Press (in Thai). 2 Hongjiao, Prof. Li. “Prevention in TCM – Medico – philosophical Aspect.” Paper presented at the International Conference of the Concept of Health and Disease from the Viewpoint of Four Cultures, Vienna University and Sigmund Freud Privat Universitat, Vienna, Austria, 31 May 2013. 3 Lishan, Prof. Zhang. “The Whole – the Starting Point of Understanding Disease in CM.” Paper presented at the International Conference of the Concept of Health and Disease from the Viewpoint of Four Cultures, Vienna University and Sigmund Freud Privat Universitat, Vienna, Austria, 31 May 2013. 4 Mahachulalongkorn Buddhist University. (1996). The Tipiṭaka in Thai. Vols. 4,5,12, and 22. Bangkok: Mahachulalongkorn Printing Press. 5 Nakatogawa, Prof. Koji. “Zheng and Qu Xian, Pre-sheaf and Manifold: Remarks to the Research on Chinese Medicine Paper presented at the International conference of the Concept of Health and Disease from the Viewpoint of Four Cultures, Vienna University and Sigmund Freud Privat Universitat, Vienna, Austria, 30 May 2013. 6 Piyachon, Prof. Dr. Chaleo. (1994). Ayurveda: Saat Hang Ceewit (Ayurveda: The Art of Life). Bangkok: Thai Traditional Medicine Institute (in Thai). 7 Ratarasarn, Somchintana Thongthew. (1989). The Principles and Concepts of Thai Classical Medicine. Bangkok: Thammasat University Press. 8 Schulz, Andreas. “Popper, Feyerabend and Constructive Realism.” Paper presented at the International Conference of the Concept of Health and Disease from the Viewpoint of Four Cultures, Vienna University and Sigmund Freud Privat Universitat, Vienna, Austria, 31 May 2013. 9 Sirikanchana, Pataraporn. (2012). In Search of Thai Buddhism Pathumthani: Thammasat Printing House.
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Subcharoen, Dr. Pennapa. (ed.). (1995). The History and Development of Thai Traditional Medicine. Bangkok: Chi Hua Printing. 11 Vamanond, Manoj, and Sabcharoen, Pennapa (eds.) (1994 Ya Thai (Thai Medicine). Bangkok: Thai Traditional Medicine Institute. (In Thai). 12 Yang, Prof. Liu. “Health Preservation in Emotion.” Paper presented at the international Conference of the Concept of Health and Disease from the Viewpoint of Four Cultures, Vienna University and Sigmund Freud Privat Universitat, Vienna, Austria, 31 May 2013.
About the author Assoc. Prof. Dr. Pataraporn Sirikanchana
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Thammasat University, Thailand
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Thai Traditional Medicine in Thailand Health System Anchalee Chaiyasuj (Thailand, Ministry of Public Health)
The Kingdom of Thailand has its own system of traditional medicine called “Thai traditional medicine “(TTM)”. It originated during the Sukhothai period (1238-1377) and developed in parallel with the country as a means of national health care until the early 20th century. The spread of modern medicine from the Western world to the East then led to decline in the practice of traditional medicine in Thailand. As a result, modern medicine eventually replaced TTM and became Thailand’s mainstream health-care system while TTM was neglected for over 60 years until the revival of TTM began in the late 1970s.1 The Western health-care system cost two billions of baht annually.2
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The contents in this paper are as follows: 1. Medical Care Systems in Thailand 2. Chronological Development of Thai Traditional Medicine 3. The National Health System 4. Current Situation of Thai Traditional Medicine 5. Basic Concepts and Principles in Thai Traditional Medicine 6. Conclusion
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1
The Medical care systems in Thailand3
The Medical care systems in Thailand are divided into 4 categories: (1) Conventional or Western Medicine (2) Thai Traditional Medicine (TTM) (3)Indigenous or Folk Medicine (4) Alternative Medicine
2
Chronological Development of Thai Traditional Medicine4
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Thailand is the Kingdom. The King take care his citizens as his sons and daughters. So the development of public health in Thailand has been associated with the monarchy institution since the Sukhothai period. Utilization of TTM appeared since before Sukhothai period, more than 700 years ago. A stone inscription from King Chaivoraman VII of the Khmer Kingdom indicated that 102 hospitals call arogaya sala were built to serve people throughout that Kingdom, including the northeastern part of today’s Thailand. In Ayudhaya period, (1350-1767 AD), in the reign of King Narai the Great, the first official textbook of TTM compiling drug recipes used by 7 royal physicians in the royal court of the King. Three of them were foreigners (Chinese, Indian and westerner.)
Rattanakosin period (1782-present) After the new capital was moved to Bangkok where the Rattanakosin period began in 1782. King Rama I (1782-1811), King Rama II (1809-1824) and King Rama III (1824-1851) played an important role in the revival of TTM that was lost or destroyed during the war (the war between the Kingdom of Thailand and the Kingdom of Burma). Over 1,000 drug recipes and the knowledge of TTM regarding the origin of diseases and their treatments, the principles of Thai traditional massage and stretch exercise called ‘ruesi dadton’ were gathered and inscribed on marble tablets and placed on the walls of two temples, namely Wat Pho and Wat Raja Orasaram.
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The reign of King Rama V (1868-1910)
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The first medical textbook called Paetsart Songkroh covering both Thai traditional medicine and western medicine disciplines were published for use at Siriraj medical school (the first Western-style hospital and medical school). The first Thai national formulary called Tamra Paetsart Songkroh Chabab Luang as well as Tumra Vejasuksa, the first TTM textbook for medical students, were published. They are still official textbooks of TTM recognized by the Thai Food and Drug Administration (FDA) for the registration of traditional medicines. Several drug formulae in this textbook were selected as traditional household remedies and in the current National List of Essential Medicines.
The reign of King Rama VI (1910-1925) The Medical Act B.E. 2466 (1923) was promulgated for controlling of the practice of the art of healing led to the decline of the practice of TTM.
The reign of King Rama IX (1946-present) In 1982, Ayurvedh Vidhayalai School (Jevaka Komarapaj) was established By Professor Dr.Ouay Ketusingh for the teaching of applied Thai traditional medicine (3-year curriculum) (ayurvedh here literally means “ the knowledge of life” not the ayurvedic medicine in India, according to Dr. Ketusingh). Nowadays this school is a part of Faculty of Medicine Siriraj Hospital Mahidol University, teaching applied TTM (4- year curriculum).
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In 1989, Collaborating Center for the Development of Thai Traditional Medicine and Pharmacy was established by the Ministry of Public Health. In 1993 Institute of Thai Traditional Medicine (ITTM) was established under the Department of Medical Services by upgrading the above collaborating center to the institute level. In 2002, Establishment of Department for Development of Thai Traditional and Alternative Medicine (DTAM) under the Ministry of Public Health.
The Department for Development of Thai Traditional and Alternative Medicine (DTAM)’s Responsibilities (1) Enforcing The Protection and Promotion of Thai Traditional Medicine Knowledge Act B.E. 2542 (1999) (2) Development and management of TTM knowledge (3) Scrutinizing CAM knowledge (4) Integration of TTM and selected CAM in the health care system (5) Setting up the standard of TTM and CAM services
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3
The National Health System3,5,6,7
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The enactment of the National Health Act 2007 was a major point in the Thai health system in the movement towards its goal by expanding the medical and public health sectors in society to “All for Health and Health for All approach”. The National Health Act 2007 is widely recognized as the first-ever act in Thailand that the public participation plays a key role in the making from the outset. In 2007, the National Health Act was enacted and served as an effective tool to set guidelines on the national health development in which all parties in society have a hand. The National Health Act is regarded as a key instrument to create opportunity for everybody to make contribution to the national health system. In this Act, “health system” means various systems that cover the operation of health activities in all dimensions. One of the components of the overall health system is “System for Promotion, Support, Utilization and Development of Local Health Wisdom including Thai Traditional, Indigenous and other Alternative Medicine”. The important process mentioned in the act is “Health Assembly”. The National Health Assembly must be held on once a year. One of the results of the 2nd National Assembly 2009 is “Developing Traditional Thai Medicine, Folk Medicine, and Alternative Medicine as the Country’s Major Health System Parallel to Conventional Medicine”. All sectors who participated in the assembly are setting up action plan in their responsibilities.
4
Current Situation of TTM8,9,10
(1) TTM services in health security systems TTM services are covered by all three health security systems: a. Welfare for medical treatment of government officials including their spouses, children under 20, and parents, cover 5 Million of people. b. Social security system of the Social Security office for employees of private business, cover 10 Million of people. c. Universal Health Coverage Scheme (UC) of the National Health Security Office (NHSO), cover 48 Million of people. However, the benefit of TTM services by each system are vary.
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(2) Public Health Services Facilities Providing Health Services In 2012, there are 10,692 public health service facilities under MoPH providing TTM services. Of these, 95 are regional or general hospitals, 733 are community hospitals, and 9,864 are tambon health promotion hospitals (formerly health centers). (3) The list of herbal medicines in the National List of Essential Medicines To promote the use of herbal medicines and Thai Traditional medicine in the health care system, in 2011, the list of herbal medicines in the National List of Essential Medicines was expanded from 19 items to 71 items, 21 are single herbal medicine and 50 are Thai traditional medicine recipes.
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(4) Financial Support on TTM The National Health Security Office was established in 2002 by the National Health Security Act to create health security for every Thai citizen. In 2007, the NHSO established the “Fund for the Development of Thai Traditional medicine System” providing additional on-top funding for public health services facilities that provide TTM services. The funding has gradually increased from 0.50 baht to 7.20 baht per capita in 2012, while the total funding per capita is 2755.60 baht. The on-top funding was given for out-patient TTM services: Thai traditional medicines and herbal medicines, Thai traditional massage for therapeutic and rehabilitative purposes, and for post-partum care. This way of allocating budgets also benefit the efforts to extend health care into the communities and promoting public participation in the health care service provision under the universal health care scheme.
(5) Thai Traditional Medicine Education In 2012, 9 qualified universities offering Bachelor’s degree in Thai traditional medicine, 8 qualified universities offering Bachelor’s degree in Applied Thai
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traditional medicine, and 4 qualified universities are offering postgraduate courses in Thai traditional medicine.
(6) Regulation In the past the licensing and the regulation of the practice of “Thai traditional medicine doctors” are under the authority of “Thai traditional and Applied Thai traditional medicine Profession Commissions”. Since the enactment of Thai Traditional Medicine Profession Act 2013, on 1st February, the licensing and the regulation are under the “Thai Traditional Medical Council” that is on the process of setting up.
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5
Basic Concepts in Thai Traditional Medicine1,11,12
TTM is based on the principles of Buddhism, cultural medicinal practices, and traditional philosophies. Buddhism has dominated Southeast Asia for over 700 years. After that, Buddhist principles were integrated into local belief systems and then became the Thai worldview that shaped both cultural ways of life and the core of thought in Thai beliefs. Traditionally, Buddhist temples or wats were community health care centers and monks served counselors, healers, herbalists as well as spiritual leaders to their local people. Even after introduction of modern education and western systems of health care, monks are still directly involved in the promotion of health care services and have been taking part in the health care reform process at grass-roots levels. The impact of Buddhist basic beliefs has been gradually replaced by scientific beliefs and consumerism beginning a century ago, but the limitations of scientific applications turn many organizations toward investigating Buddhism as another point of view and an alternative method for problem solving. For Buddhism, a religion that denies the existence of one God or other creators, the world or all existences are believed to have originated from many causes that are governed by the natural law. There is no primary cause or a basic component that works as a determinant causing something or an event to happen. Each cause or determinant relates to others while all are interdependent. The results of those interrelated create a variety of effects. The world, in Buddhism, is not perceived as a material entity or a planet that we have to discover its origin
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or its components. Buddhism is more concerned with the world as a sense-object and mind-object which are observed or recognized by humans through the six sense-organs or bases; eyes, ears, nose, tongue, body, and mind. Existences, in Buddhism, perceive as far beyond the material world to include the immaterial spheres that cannot be detected by normal sense-organs and scientific tools. The Buddha mentioned about many other beings or places such as Deva (diety), Yakkha (demon), Peta (hungry ghost), Heaven, Niraya Hell, downfall, etc. in many sutras in the Tipitaka. Buddhism believes that human beings are under the control of natural laws. One is the law of kamma. The law of kamma is the aspect of natural law which governs those human actions which have some ethical or moral value. It is the law that determines the results that certain actions will produce. Nature has its own systems of settlement, and the fruition of deeds (kamma) in their results is one of nature’s systems. It’s essence will be summarized in the following passage: “Whatever seed a person plants, That is the fruit he receives. One who does good receives a good result, One who does bad receives a bad result”.
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The Principles of Thai Traditional Medicine13,1,14,15,16,17,18 The causes of illness The practice of TTM is based on the premise that there is always a cause of illness that the causes can be specified, and that abnormality in one or more causal factors can produce recognizable symptoms of disease. TTM is based on Buddhism, cultural medicinal practices, and traditional philosophies. So human illness can be caused by the following factors: (1) Powers of nature: the imbalance of body, the imbalance of body and mind and the imbalance of body and environment. (2) Powers of the universe: the influence of sun, moon, and stars. (3) Supernatural powers: ancestor souls, evil spirits, punishment from spirits for misbehavior, and Incantation (4) ehaviour (5) Kimijati, which is the equivalent of microorganisms or parasites Main “samutthan” (Primary causal factors of disease)
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In the Thai system, tard or the elements, may be called ‘host’ compared to Western medicine, utu or the seasons, ayu or age, kala, and prathet or time are the main “samutthan” or causal factors of disease. May be called ‘primary cause of disease’, or compared to Western medicine. (1) The four ‘Tard’ or elements The human body is composed of four elements i.e., din or earth, nam or water, lom or wind, and fire. This concept has much in common with the thought of the ancient Chinese, Greek, and Indian philosophers. Each element refers not to the physical substance but to the qualities of that substance. The maintenance of health depends on the harmony of the elements. When the four elements of the body are in equilibrium, it will be healthy. In contrast, if an imbalance in these elements occurs, i.e., if there is a deficit, an excess, or disability in any of the four elements, a person will become ill. The elements have each of them regulatory system called “dhatu pigad samutthan”. These reguratory systems that are the most factors of disease are: di (bile), lom (wind or air), and salet (mucus).
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“Tard -chao-ruan” (the dominant element of the body) According to TTM, for each person there will be one element that is more dominant than others, one’s own dominant element is called “tard-chao-ruan”, which is basically determined by the date and month of one’s conception. The tard-chao-ruan of a person plays an important role with regard to one’s characteristics and appearance as well as the weak point in one’s health. This is the Zodiac causal factor. 42 components of the body are classified as elements which cause disease: 20 of the element earth, 12 of the element water, 6 of the air, and 4 of the element fire. The 20 components of the element earth are: hair, body hair, nails, teeth, skin, flesh, tendons, bones, tissues in the bones, spleen, heart, liver, fascia or connective tissue, kidneys, lungs, large intestine, small intestine, undigested food, waste matter from intestine, and brain.
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The 12 components of the element water are: bile, mucus, pus, blood, perspiration, body fat, tears, lymph, saliva, clear mucus, fluid in the joints, and urine. The 6 components of the element air : the air that starts from feet and rises to the head, the air which starts from the head and ascends to the feet, the air in abdominal cavity, the air which circulates in the intestines and stomach, the air which circulates throughout the body, and the breath. The 4 components of the element fire: body heat, the heat which makes the body feel hot and uncomfortable, the heat which causes senility, and the heat to digest food causes it’s decomposition. This system of classification is quite different from that used in modern medicine. This classification takes a comprehensive view of the human body as a complete and coordinated organism. Given this concept of the body as a whole.
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(2) Utu or seasons The relationship between climate and environment and disease is recognized by most medical systems. At the changes of seasons throughout the year, with such mixtures of hot, cool, cold weather, the association of the external and internal “tard” creates imbalance in men’s body. During changes of seasons, there is a tendency towards variable weather, which causes abnormal conditions. A person’s body “tard” may not adjust quickly enough, so that, when they clash with the unseasonable weather, illness results. In modern medicine, the increase in the incidence of certain diseases at particular times of the year, such as the common cold and influenza in winter, are examples. (3) Ayu or Age Age is divided into three periods: early age, from birth to 16 years; middle age, from 16 to 32 years; and old age, from 32 years. The age of the patient is considered to be one of the primary causal factors of disease. Early age is divided into two periods: from birth to 8 years, and from 8 - 16 years. During the first period, the major cause of illness is mucus. Diseases occurring during middle age, from 16 to 32 years, are cause by the element water. The element air is the causes of disease of old age, from 32 years. 302
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(4) Kala or Time Astrologically, the sun, the moon, and the stars continuously move, thereby influencing human life and health differently during different times of the day. Time refers to the time of day or night, each of which is divided into four periods. Kala is the primary cause of the disease. The different time make the different disorders of the element function or regulatory system. (5) Prathet or Place Prathet means that the place of residence at the time of the onset of the disease is the primary cause of disease. Whether the climate is hot or cold, people become accustomed to it, and so do the ‘tard’ in their bodies. When anyone changes his place, he might get an illness, because the ‘tard’ themselves are not accustomed to the place. This is likely in modern medicine, some place is prone to malaria or parasite some are not. This is the imbalance of internal ‘tard’ and external ‘tard’ or environment.
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Behaviour Inappropriate behaviours that can be the causes of ailments according to TTM are as follows: (1) Inappropriate eating habits, e.g., eating too much or too little, eating food that has gone bad, or unfamiliar food, or food that is not suitable for one’s own dominant element or diseases. (2) Imbalance postures while sitting, standing, walking, or sleeping can lead to disequilibrium of the body structure and needless worsening of health. (3) Exposure to extreme weather or polluted air. (4) Being deprived of food, water or sleep. (5) Delayed urination or defecation. (6) Overwork, over-exercise, or excessive sexual activity. (7) Deep sorrow or extreme exhilaration. (8) Extreme anger, lack of equanimity. This is in accordance with Buddhism, which teaches that sorrow arises from man's emotional attachment to worldly things. The stopping of sorrow leads to enlightenment, and this is achieved by following the Middle Way, the path of
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moderation. Disease is a form of sorrow, and immoderate behaviour is considered to be a cause of disease. This principle cause of disease, behaviour, is the same in ‘behavioural medicine’.
Kimijati 80 kinds of parasite infect children that eating food they have not eaten before. Disease occur when kimijati grow up.
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Treatment TTM uses various forms of practices to complement each other, i.e., medicine, pharmacy, massage, midwifery, and maternal and child health care, Buddhist rites, and meditation, as well as other rituals based on the belief in supernatural power and power of the universe. TTM is considered a holistic form of medicine. Treatment emphasizes adjusting the balance of the body elements using the health promotion approach. Naturally determined factors, e.g., tard-chao-ruan, seasons, and others shown in the TTM causes and principles are considered in order to give appropriate treatments. In addition, the TTM health promotion approach is used to achieve good health, for example “ruesri-dadton”, appropriate foods, and “dhammanamai”.
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6
Conclusion
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Similar to other countries, Thailand has its own form of traditional medicine as national wisdom for health care. TTM is a holistic and natural approach of health care that is derived from Buddhist beliefs, the observation of and respect for nature, and the wisdom of Thai ancestors. In addition, traditional knowledge of TTM was also built through the processes of “selection”, “adoption”, “adaptation” and “utilization” of tradition medicine of some countries with which Thailand had contact in the past, to suit the Thai way of life. TTM uses various forms of practices to complement each other, i.e., medicine, pharmacy, massage, midwifery, and maternal and child health care, Buddhist rites, and meditation, as well as other rituals based on the belief in supernatural power and power of the universe. It has the policy to integrate traditional medicine into the mainstream health care system. So that Almost 100% of health service facilities of MoPH provide TTM services. However it need more of government commitment, good administration, information system development, R&D, good collaboration among communities, the institutes and organizations concerned at both national and international levels.
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MULHOLLAND J: THAI TRADITIONAL MEDICINE: ANCIENT THOUGHT AND PRACTICE IN A THAI CONTEXT. http://www.siamese-heritage.org/jsspdf/1971/JSS_067_2i_Mulholland_ThaiTraditionalM edicine.pdf (accessed 16 March 2013). 14 Department for Development of Thai Traditional and Alternative Medicine, Ministry of Public Health (2012). Thai Traditional Medicine History and Principle. Bangkok: Imagine Graphic. P. 1-41 (Thai). 15 Ayurvedh Vidhyalai School (Jevaka Komarapaj) Thai Traditional Medicine Promotion Foundation (1998). Tamra Kanpaetthaiderm (Paetsartsongkroh) Chabab patthana volume 1. Bangkok: Si Thai Printing. P. 4-5 (Thai). 16 Prayaphissanuprasatvej. (ratanagosinsok 127: A.D. 1908). Vejasuksa. volume 1,2 and 3. Bangkok: Vejasamosorn school. P. 1-10, 12-14 (Thai). 17 Phadphanboran school Prachedhupon temple (1951). Phatsartsongkroh volume 1. Bangkok: Phadphanboran school Prachedhupon temple. P. 179-181 (Thai). 18 Khun Sobhitbhannalaksana (n.d.). Khampiphatthaiphanboran volume 2, p. 122-123 (Thai).
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About the author Dr. Anchalee Chaiyasuj M.D., M.P.H., Cert.in Fam.Med. Director of Thai Traditional Medicine Research Institute, Department for Development of Thai Traditional and Alternative Medicine, Ministry of Public Health ,Thailand
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Chapter 5
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Aspects of Health from the Viewpoint of Islamic Culture and Philosophy
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Spiritual-Religious Family Therapy: History, Theoretical and Experimental Bases and its Techniques and Principles Mohammad Khodayarifard (Iran, University of Tehran) Gholam Ali Afrooz (Iran, University of Tehran) Sayyed Mohsen Fatemi (The University of British Columbia) Yasamin Abedini (University of Isfahan)
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Abstract Today, in most families, religion and family life are deeply integrated and inseparable. The conducted studies on family processes have shown that spiritual and religious beliefs and behaviors have an important role in family health performances. Nevertheless, mental health researchers, especially those interested in family psychology, are seeking to understand and explain how and why religion and spirituality can affect family performances and outcomes. Accordingly, the aim of this study was to introduce the spiritual-religious family therapy approach and explain how religion and spirituality would influence family performances based on the current concepts on role theory, social support network, stress and coping perspective. After explaining spirituality and religion and reviewing the history of the application of spiritual-religious techniques to family therapy, a number of major principles of this approach were mentioned and the therapy techniques of “forgiveness” and “positivism”, as two dominant techniques which have been both theoretically and experimentally supported in the field, were briefly explained. Finally, the current limitations for conducting studies of religion and family matters were discussed and further suggestions were provided for future studies.
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Key words Spirituality, Religion, Family therapy, Principles, Techniques and theories
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Introduction Spirituality is one of the most powerful human experiences and is of significance in today’s world. Spirituality is concerned with fundamental human questions on the world, the reason for its creation, its regulation, its evolutionary trend and purpose and end of human life in this world and questions like this. It is a concept which has a strong relationship with religion. In the not-too-distant past, spirituality was viewed as a phenomenon with no standpoint in education and clinical activities and most of mental health specialists considered the spirituality of their clients as a completely private issue. The assumption was that the best way is to hand them over clerics and religious scholars. Some were concerned that psychotherapists might impose their religious beliefs on the clients. There were other concerns on the strong feelings and differences which might result from spiritual issues. Nevertheless, during the recent decades, researchers, scholars and theorists in different fields of sociology, psychology, religious studies and medicine have again concentrated on religion, spirituality and the performance of these human experiences in physical, social and mental health. Psychology and its different branches (like clinical psychology, social psychology, developmental psychology, personality psychology, health psychology and family psychology) are among the disciplines which are interested in spirituality, religion and their performance in mental health and human promotion. Although investigating and studying the role of religion in family interactions dates back to 1930s, today there is growing interest on the part of experts and researchers of family psychology in this phenomenon (Dollahite, Marks and Goodman, 2004; Jenkins, 1991) and approaches based on strengthening internal protective processes in humans encourage them to identify their personal and internal capacities and resources (like religious and spiritual beliefs and convictions) while working with their families and use them for reducing their vulnerability. In fact, clinical specialists make less emphasis on using therapeutic techniques and more emphasis on using the basic balance in the family in order to apply potential spiritual capacities inside the family for therapy and problem solving purposes (Minuchin, 1992; Walsh, 1999). Thus, according to the observation in recent cases, 81% of respondents expect their therapists to consider 312
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their spiritual behaviors, beliefs and convictions during the counseling and therapy process and combine them with their therapy process (Bergin and Jenssen, 1990). Satir (1927-1988) cooperated with those family therapists who believed in the existence of transcendental spirituality in relation to their clients. Today, many therapists have started to break the current limitations and constraints in order to identify methods for entering spirituality into the therapy process of psychotherapists (Anderson and Worthen, 1997; Becvar, 1998) and have suggested spiritual approaches for working with religious families (Griffith, 1986; Walsh, 1999). In the meantime, some of them believe that moral, religious and spiritual beliefs and convictions of a therapists and a client can be a powerful source which can be used during the therapy process (Frankl, 1955; Frame, 2000). Following the proposal of these spiritual approaches to family therapy, researchers have not only been interested in studies in this regard, but also tried to identify and solve current conceptual, methodological and analytical issues and challenges. Most of the studies conducted with regard to the relationship between religion and family performances have concluded that: 1) religion forbids unacceptable personal and interpersonal behaviors and actions. In fact, one of the practices of religion in family is to act as an agent of social control; in other words, religion bans some personal behaviors and, at the same time, suggests and promotes special rituals, ceremonies and beliefs (for instance, communication and respect for one another, forgiveness and resolving conflicts and clashes between people which leads to marital and family satisfaction and increases coherence, solidarity, affection and cooperation between the couples and family members (Dollahite and Marks, 2005); 2) religion develops a collection of social practices, norms and beliefs which strengthen the identities of major roles in family (like the role of father, mother or role of husband or wife) and defines a special meaning for each of the roles leading to satisfaction in people who have these roles (Ellison, 1994); 3) religion has an important role in coping with stress and family life incidents and problems (Werner & Smith, 1992; Diblasio, 2000); 4) religion creates special supportive and communicative networks in the family and leads to more cooperation, empathy and intimacy between couples and family members (Howe, 2002; Chatters and Taylor) and 5) Religion creates positive emotions and excitement in family members (emotions like hope, positivism, being in authority and will) and forms helpful and effective schemes and orientations (like family hardiness and flexibility in the family) (Coles, 1990; Oxman,
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Freeman and Manheimer; 1995). Nevertheless, those scholars who have investigated the relationship between religion and spirituality and family performances have faced obstacles and problems like measuring religious beliefs, making an experimental distinction between spirituality and religion, identifying the effect of socio-political contexts on religion and its performances and the diversity of various religions and the distinctive effect that each of these religions has on people’s behaviors and practices. Considering the growing interest in the effect of religion and spirituality on personal and family performances and the extent of conducted studies, the main aim of this study was to introduce a spiritual-religious approach for family therapy and to investigate history, theoretical and experimental bases and principles and techniques and problems with which they are facing. To this end, first, a definition was presented for spirituality and religion; then, a brief overview was given on the history of religious approaches toward therapy and family therapy. After presenting basic theories of this approach along with its principles and techniques, the current challenges and obstacles were explained.
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Defining Religion and Spirituality Identification, definition and precise understanding of spirituality and religion would be of great significance since these two terms are usually considered synonymous and are interchangeably used. Wright, Watson and Bell (1996) made a helpful conceptual distinction between religion, as a system of beliefs and convictions which are externally structured, and spirituality, as a system of structured beliefs and practices which are internal. In other words, religion is a system of beliefs which consists of shared (and often institutionalized) moral values, belief in God or a transcendental power and force and membership in a faith community. Spirituality is an extended structure and includes beliefs, convictions and more general and comprehensive transcendental behaviors. Spirituality can be experienced both inside and outside of the formal religious structures and is more personal (Walsh, 1998; Elkins, 1990). Stander et al. (1994) believed that spirituality focuses on active investment of a collection of internal values and gives the person feelings like being meaningful, integrity, unity and internal and external coordination (unity with others, life, nature and the world). Therefore, a spiritual person can or cannot believe in a special religion. Swenson (1999) believed that religion consists of sacred social and personal ex314
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periences which are expressed as a system of beliefs, practices, rituals and special ethos. Personal sacred experience is the main characteristic of any religion which is called “spirituality”. Social sacred experience includes doing common and social religious worship and rituals. Although the scholars in the field of psychology, religion and spirituality have made a distinction between these two structures in terms of concepts and theories, they have not been so much successful in making an experimental distinction between religion and spirituality (Chatters and Taylor, 2005). Nevertheless, studies have shown that both personal and individual aspects of religion (or spirituality) and its social aspect have main roles in the health of people who face up with life crisis (Chatters, Lewin and Taylor, 1992).
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History of Formation of Spiritual-religious Approaches for Psychotherapy and Family Therapy Although psychotherapy has been rooted in spiritual healing traditions, as a result of development and growth in the field of mental health, a kind of separation is observed between faith-based paradigms and scientific paradigms, In fact, spirituality and psychology have common historical and linguistic roots since “psyche” is a Greek term which means “spirit” and also, in many cultures and ethnicities, mental disorders like schizophrenia are considered as becoming a takeover by ghosts and devils (Falicow, 1998). During the centuries, wizards of each tribe had the role of therapists among their tribes and had a holistic approach toward physical, emotional and spiritual (mental) healing (Some, 1994; quoted by Khodayarifard and Abedini, under publication). In the early twentieth century, the ideas of Freud (1927-1961) based on the opposition to religion, as a kind of unrealistic, annoying and anxious imagination, had a strong impact on the separation of spirituality and religion from psychotherapeutic practices and theories. Nevertheless, Yung (1933-1958) was one of the therapists and theoreticians who believed that spiritual healing and excellence require a relationship between mind and religious beliefs. In fact, Yung believed that health and spirituality are ineluctably tied to one another. As psychotherapy turned to a specialized profession which owed its knowledge to experimental and scientific efforts, this separation became more evident so that the experts in the field of mental health showed more interest in separating spirituality from spiritual phenomenon (Johnson, 1998); however,
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with the growth of qualitative approaches to discovering and identifying personal experiences and meaning, a new trend of interest in studying religious beliefs, faith and spiritual and religious practices as healing personal meanings and experiences was formed and prepared the field for doing research on the effect of religion and spirituality on mental health (Hood et al., 1996), physical health (Koenig et al., 1998) and family health performances (Beavers and Hamson, 1990) so that today there are coherent theories in this regard. In the following sections, the relationship between religion and family performances are investigated considering three theoretical frameworks of “role theory”, “stress and coping” and “social support networks”.
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Role Theory This theory is related to the methods which define life roles and social relations of a person and make the concept of self and behaviors meaningful. Important dimensions of roles which people experience include role identity, role duties, role conflict and role negotiation. Role theory believes that both the person who plays the role and the people who are important for his/her life and the expectations which this person have from that special role affect the definition of that role. Thus, religious texts and religious beliefs and meanings of family members have a role in determining role identities in a family and the relationships and behaviors of the members of that family. Religious teachings derived from holy books provide guidelines with regard to the appropriate behaviors and attitudes related to family roles (for instance, about the mutual relationship between parent and child); also, holy texts and books warn people about negative consequences of family conflicts and precisely determine and define the duties of each role (for instance, duties of a husband and wife against each other); therefore, they influence the formation of attitudes and relationships with the role (Ellison, Bartkowski and Anderson, 1999). Performing religious duties and rituals which are related to turning points in family life (like birth, death and marriage) increases a sense of solidarity, cohesion and unity in family members (Howe, 2002). Participation in mourning ceremonies and religious holidays strengthens family commitment, relationship and continuity. In this regard, Ellison et al. (1999) investigated the relationship between religion and domestic violence and found that the level of domestic violence was significantly lower in families with more
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participation in institutions, religious services and churches compared with the families which did not participate in these religious institutions.
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Stress and Coping Perspective Stress and its coping strategies have been investigated in relation to different scientific fields like biology, behavioral sciences and social sciences. Family psychology and family therapy are the fields which are interested in the issue of why and how families are different in terms of their capabilities of coping with normative life transfers (like becoming a parent, retirement and death), non-normative life problems, incidents and events (like diseases and losing a job), catastrophic events and incidents (like war) and natural disasters (like flood and earthquake). Family therapy makes an emphasis on family strengths and capacities which help families to endure problems and disasters (like coping behaviors and resources). Important structures of this approach include mental pressures, primary and secondary evaluation and coping behaviors and resources. Primary evaluation includes the evaluation of the person from the level of a stressful event or incidence and secondary evaluation includes the evaluation of a person from his/her capabilities for coping with an incident or stressful factor. People are different in terms of their selective methods for coping with problems; some use a problem-oriented approach (active coping, information collection) and some others apply an emotion-oriented approach (distractibility, avoiding) for coping with problems. Coping efforts can focus on assigning meaning to a traumatic or stressful event and mobilizing social and personal capacities and forces for coping with that event. Meaning-based coping style is based on re-interpretation of a traumatic factor according to its spiritual and final importance for the person. In this type of coping, a person attributes positive spiritual and religious reasons and explanations (like God’s will and sin forgiveness) or negative spiritual and religious reasons and explanations (like being punished by God) to traumatic factors and decreases the negative effect of that factor (Pargament, 1997). In fact, religious practices and beliefs affect the person’s primary and secondary evaluation from a traumatic factor. For example, in religious families in which people believe that merciful, powerful and generous God always protects them from problems, less threatening traumatic factors are evaluated and people feel more powerful for coping with those problems and have more hope for their removal and solution (for instance, believe in God’s
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capabilities, miracle and healing). Religion has a role in the coping process; when a family loses an endeared person, family and social relationships and religious rituals and ceremonies help them to reach compatibility more easily, especially those people who consider death as a start for the Hereafter suffer from less sorrow because they know death as a kind of divine providence and fate and a kind of surrender to God’s satisfaction (Koenig et al., 2001). Although sometimes spiritual coping is considered a kind of inactive coping, the results of studies have shown that spiritual coping strategies (like trust in God and submission to the satisfaction of God) comes with reduction in anxiety, sadness, searching for meaning and social cohesion (Pargament, 1997). Praying, as one of the most important spiritual-religious coping ways, can be done individually or collectively in families or holy places. When family members pray collectively, their family relationship and cohesion increase, their relationships become more intimate and they receive more social protection; all these factors act as a buffer and decrease stress (Krause et al., 2000b).
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Social Support and Network Perspective: There are no formal and coherent theory on social support and network. Social networks include a collection of relations which surround people and are different in terms of extent, assimilation and contrast. Social support refers to those social interactions which act as emotional help, support and confirmation. These supports are either executive (like receiving emotional, material, spiritual and information support) or perceptive (like predictive support) (Krause, Liang and Keith, 1990). In an extensive study by Taylor and Chatters (1996a), the informal social support received in American-African churches were investigated. They found that more participation of American–African children in churches increased their support from their elderly and aging parents and this led to more cohesion and unity between family members. Different religions can help their followers as a social support network and give them spiritual and material support by establishing charitable institutions and funds or through collective praying. Nye (1993) performed a case study on Black American families and found that these families received emotional, spiritual and material support from their fellows and religious charities while facing poverty, racism and other problems and these
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supports had an important role in the mental health and compatibility of these families. In fact, groups of believers can be supportive and helpful, even more than the amount required by people. These groups help to bear sufferings and failures easier and join other people by their collective praying; in the hardships, faith is vulnerable and these groups help for returning it. In other words, groups of believers cover us by their support and attention; thus, group praying can change people. Joining the group reveals that we are not alone; when we speak with other members of the group, we notice that others have sufferings like us; in some cases, they have more suffering experiences (Payam Moshaver, 2007).
The Effect Processes of Religion on Family Performances
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Dolahite et al. (2004) conducted a qualitative study on 60 Jewish, Christian and Muslim religious families and presented a three-componential model for the process through which spirituality and religion affect family outcomes and performances. This model can be observed in Figure 1.
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Findings
Processes
Spiritual and religious goals, beliefs and practices
Working together achieve goals
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Spiritual beliefs: religious ideals and beliefs, religious goals and purposes, relationship with God, religious rituals and teachings, holy and transcendental goals and meanings Religious practices: holding holy traditions and rituals, praying, reading holy texts and books, holding religious ceremonies and religious mourning, alms giving, doing charity, vowing, fasting and restraint Religious communities: collective praying, establishing charitable institutions, collecting donations and collective and group support
↔
Results and Outcomes to
Turning to God to receive help, support, guidance and power Sanctity of family via involving family life with religious teachings and solving family conflicts through praying, forgiveness and repenting Serving family members and helping religious communities and places Coping with traumatic factors and problems via religious practices, avoiding forbidden practices and eating forbidden foods Using lawful (Halal) money, properties, equipment, facilities and recreations by family members Enriching moral and spiritual growth by education, discussion and exemplification
Collective, family, marital and personal gratefulness
↔
Health, peace, safety and personal comfort Physical, intellectual, attitudinal, spiritual, emotional health and longevity, being meaningful and having orientation, peace, spiritual growth, trust, sense of satisfaction and happiness Marital satisfaction and trust; honesty, commitment, solving conflicts, cohesion, cooperation, common viewpoints, stability, intimacy, respect, clarity of roles and common goals Social support; social, material and spiritual support from "religious brothers and spiritual and religious families" all through life, making deep, supportive, stable and permanent relationship
Figure 1. Effective outcomes, processes and contexts in efforts of family members for obtaining the goals
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It can be observed that religious practices and beliefs highly affect family members’ physical, emotional and mental health and welfare. Below, the principles and techniques of spiritual-religious family therapy are discussed.
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Principles and Techniques of Spiritual-Religious Family Therapy In modern societies, mental health experts need to consider spiritual dimension at the time of therapy. In a recent survey, 75% of respondents preferred psychotherapists and physicians who considered spiritual issues as a main part of their work (Bergin and Jenssen, 1990). In addition, when spiritual and religious beliefs and perspectives of clients are not considered during the therapy process, they feel lack of coherence and think that their thought and existence are being separated (Griffith and Griffith, 1999). Therefore, as it is required for a family therapist to ask about ethnicity, race and culture of the client, s/he should identify the clients’ spiritual and religious dimensions and characteristics. Therefore, a psychotherapist should clarify whether these people have a special religion (like being Muslim, Jewish and Christian) and deeply believe in them or their family background has pushed them toward having these religions. Moreover, it is very important for the therapist to find out whether family members characterize God as a kind or heavy punisher and judge. Frame (2000) designed a spiritual family tree which was used for evaluating religious relations and spirits of family members for several generations and even found their religious contradictions. While working with the clients, it should be determined how they have combined their spiritual and religious beliefs and principles with different dimensions of their life based on their socio-cultural background. In many cases, religious beliefs and practices can act like a protective resource while being faced with a crisis while it is not like this for others. Sometimes, religious perceptions and imaginations among family members or couples are a justifying factor for the patterns of annoying interpersonal relationships (Whipple, 1987). It should be mentioned that, although faith and religious belief can lead to change and improvement in the psychological condition of people, their lack of improvement during the therapy process cannot be only attributed to the lack of sincerity and spiritual-religious beliefs. In this section, a number of fundamental principles are referred to which should be considered in all meaning-based therapies: Moving from self toward others
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From long ago, the struggle between self and ego has been one of the fundamental religious teaching principles. Therefore, during the family therapy process, a therapist should help the client to get distance from “self ” and “ego” and move toward “others” which is the sacred and transcendental power.
Belief in miracles Miracle is not the occurrence of an unexpected or unconditional event. Miracle happens based on real rules of life in a meaningful whole and is related to certain means (Ahoo Ghalandri, 2007). However, are we prepared to perceive an event as a miracle and do we look at the world as a dunce phenomenon? In fact, the duty of a family therapist with a religious-spiritual approach is to help the client to perceive the events and incidents in relation to justice which is governing the world and assume the events as a tool for the fulfillment of fate. A client should conclude that life events are not routine and repetitive and each of them is a sign which guides the person toward a side. In other words, a client should perceive that all the phenomena of the world are good and generous by themselves.
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Warning and annunciation Warning means becoming aware of the end of something and, as a result, is the basis to move forward or backward. Annunciation is giving hope along with the spirit of fulfillment. In spiritual-religious family therapy, therapists need to make family members aware of the punishment and appeals of their practices and perspectives and help them to select their transcendental goals while moving toward these goals with hope and reliance on God.
Now and here “Here” means “this place” in which the person is surrounded and “now” means “this moment” apart from the history in which s/he has grown up. Emphasis on “here” and “now” does not mean being separated from past and future; but, it means complete presence and indicates selection. While doing spiritual-religious family therapy, the family members should be helped to live at that moment of 322
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life. The aim is to integrate the existence of people in the world and unite body, mind and the world in which the person lives. Complete presence means that this person has chosen a goal here and now and makes an effort to reach that; however, s/he is not worried about what happens and presents other issues to God.
Accepting suffering and spiritual interpretation of suffering
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Pain and suffering are merely human issues because pain means knowing that there are lacks, limitations and failures. Accepting suffering means “making meaning” of suffering. While accepting pain, the person considers it as something internal which belongs to him/her and finds a positive attitude towards self, the world and God since s/he considers himself/ herself more powerful than the suffering and thanks God for providing fate fulfillment. The person is not dissatisfied with pain and does not ask “why does this suffering happen to me?”; instead, the question is “what message does this suffering bring to me?”. In fact, when the family members are helped to accept the pain, they will find out that each pain is a platform toward their more growth and excellence. The person surrenders to God by accepting the pain and is satisfied by God’s satisfaction.
Humility and Gratefulness The basis of humility is to eliminate centrality of self and considering self as central and to tend toward cooperation with others and the world in general. This description of humility is accompanied by continuous gratefulness. That is, the person who appreciates the world and his/her gratefulness toward a holy and transcendental force kills and eliminates his/her self-centralized tendency. Gratefulness means gratitude for anything received by the person. The duty of a family therapist is to help family members to accept events and incidents and consider them as the pre-stone for their growth and recovery; they should consider all of them as favor and have a positive look at what is ordained by God. Since, the aim of each therapy is to reach relaxation, not comfort, in fact, in spiritual-religious family therapy, the aim is to move people toward a religious and spiritual end which is reconciliation with the self, God and the world leading to obtaining deep relaxation. Thus, two cases of techniques and principles in
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religious-spiritual family therapy which have been widely applied and have been supported theoretically and experimentally are investigated here; these techniques include forgiveness and positive thinking.
Forgiveness
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During the recent decades, some studies have been done on forgiveness and its effect on the improvement of interpersonal relationships and mental health. Enright (1998) considered forgiveness as the process of passing errors and their side effects which is done by the person to obtain internal relaxation, improve the relationship with the offender and do a moral action; this process has the following outcomes: (1) being released from negative feeling toward the offender, (2) overcoming the resentment caused by being bad and (3) avoiding anger, separation and retaliation against the offender. Ritzman (1987) believed that nature and human nature can be described by pure loving and relationship with God and forgiveness is necessary for healing deep emotional injuries of humans. A brief investigation reveals that forgiveness is enumerated valuable in almost all religions including Islam, Christianity, Hinduism and Buddhism (Rye, Pargament and Amir, 2000). The results of different studies have shown that forgiveness is very effective for being recovered from mental problems, intimacy and trust in marital relationship, solving marital problems and family conflicts (Diblasio, 2000; Enright et al., 1998; Jackson, 1998). Forgiveness is an eight-step process which includes: (1) the offended person sees him/herself against a revenge feeling and a forgiving thought and thinks that, although s/he can revenge on the offender, s/he has the right to forgive, (2) in this stage, the offended person feels that his/her right violation is accepted by everyone, even the religion, and the offender has committed a sin for which there is a penalty, (3) the offended person becomes aware of negative effects and outcomes of taking a revenge and not forgiving, (4) the offended person finds out that s/he should not have bad thoughts about others in religious and humanity and, above that, s/he should consider the limitations of the offender and evaluate him/her based on his/her embargo and restrictions, (5) in this stage, the therapist can strengthen his/her positive-thinking and guide him/her toward recognizing the reasons for forgiveness in order to revise his/her feeling, (6) the therapist makes the of324
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fended person notice that forgiving is dignity and insisting on some kind of lack of amnesty is far from the values, (7) now, the offended person has passed previous stages, is searching for remedies and the therapist encourages him/her toward forgiving in order to make his/her final decision, and (8) the offended person decides to forgive and expresses that by greeting, hand shaking, kissing etc.
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Positive Thinking One of the practical and effective solutions for mental balancing is “to identify and rely on the people’s strengths” as a therapy approach. Holstein (1997) believed that, during therapy, instead of working on the pathological traits of the clients, the emphasis should be on strengthening his/her strengths. Also, in many religions like Islam, Christianity and Zoroastrian, there is an emphasis on positive thinking about the self and other (Khodayarifard, 2001). Positive thinking is one of the spiritual and religious therapy techniques which can be used individually, collectively or in family and has the following stages: (1) in the first stage, the families with family disorders and inconsistencies are asked to name their strengths, (2) in the second stage and during several sessions, each family member is asked to name at least 10 to 15 good experiences with which s/he is satisfied and happy, (3) in the third stage, there is an emphasis on some practices, during which the person can identify relative importance of the strengths mentioned in the first and second stages in the order of their priority. When positive thinking is performed in the family, after each family member talked about one good experience, other family members try to identify and record the strengths of that person according to his/her mentioned points, (4) in this stage, each family member takes a turn to tell others the positive points listed about him/her, and (5) in the last stage, the clients are asked to present their pieces of evidence and criteria showing that his/her most valuable strengths are reliable. Case studies and reports have demonstrated that individual and family positive thinking has an important role in decreasing depression, feeling inferiority and behavioral disorders and creating intimate interpersonal relationships in the family environment (Khodayarifard, 2001).
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Summary and Conclusion During the recent decades, there has been a growing interest in religion and spirituality among researchers and experts in different fields like psychology, sociology, medicine and religious studies. Family psychology as one of the branches of clinical psychology is seeking to understand and identify the effect of spirituality and religion on family performances and outcomes. Satir is one of the family therapists who clearly emphasized the existence and application of transcendental spirituality during therapy. Although the ideas of Freud about the imaginary, unrealistic and annoying nature of religion separated scientific and religious therapy paradigms for years, the emergence of interest in qualitative studies and identifying personal meaning and experience formed a new trend of considering spiritual and internal resources and their effect on emotional, mental and physical health of people and healthy family performances. New studies have shown that religion and spirituality can affect different family performances like intimacy, coherence, hope and satisfaction by social control, strengthen the identities of main roles of family, resisting traumatic factors and important family incidences, making social networks and social, emotional material and spiritual supports, making positive emotions and feelings and effective family schemes. Effective theories and perspectives for explaining the influential process of religion and spirituality on family outcomes include role theory, stress and coping theory and social support and social network. In the role theory, there is a belief that religious meaning of family members has an important effect on determining the role identities of a family and their relationship with each other and specifying the duties of roles inside the family against each other. Stress and coping perspective believes that spiritual and religious beliefs and convictions of family members can affect the primary and secondary evaluation of traumatic factors and incidents and the coping strategies applied by family members and act as a buffer which decreases pressure caused by problems and challenges. This social support and network emphasizes that belief in religion and participation in religious services and institutions act as a social support network which provides spiritual, emotional and material support for family members while being faced with problems and difficulties. The fundamental principles of spiritual-religious family therapy approach include: (1) moving from self toward others, (2) believe in miracle, (3) warning and annunciation, (4) now and here, (5) accepting suffering and (6) humility and forgiveness. Two effective techniques for spiritual-religious family therapy are forgive326
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ness and positive thinking. The results of different studies have supported the performance of these two techniques in recovering family problems and relationships. However, while using these spiritual-religious techniques in families, the following points should be considered: (1) Deciding on the combination of spiritual-religious techniques with other therapy techniques based on the precise evaluation of spiritual and religious convictions and beliefs of the clients. Therefore, it is very important not to impose spiritual and religious therapy on the client with no spiritual and religious beliefs, (2) if clinical experts fail in guiding the system of spiritual and religious convictions and beliefs of clients, the clients may leave the therapy sessions before the end, (3) psychotherapists should be aware that some clients consider therapy against their religious traditions and rituals. Experimental studies have demonstrated that some women state that they never speak about their spiritual and religious beliefs and convictions during their therapy sessions since they do not think it can be of interest for the psychotherapists (Boyd- Franklin, 1991), (4) the differences which exist in spiritual and religious beliefs of family members may create conflicts or disagreements between children and their parents. These problems are created when one teenager or one of the family members tends to another religion and tries to change his ancestral religion (for example, from Christianity to Islam). In such cases, the therapist gathers all family members together and guides them toward mutual understanding and increases their patience for tolerating and facing religious practices and beliefs other than their ancestral ones, and (5) psychotherapists should be aware of the point that sometimes psychological syndromes like depression, stress and psychosomatic disorders or conduct disorders of one of the family members are caused by the death of one another or an endeared one. Therefore, by entering spiritual and religious orientation and religious spirit to the therapy process, the therapy process is facilitated. As mentioned before, the results of various studies related to religion and family in different countries on different religions show that emphasis on religion and spirituality in families may lead to the following results: a. Peace, relaxation and emotional, spiritual and physical health, longevity, meaning, orientation and satisfaction. b. Happiness, trust and honesty in marital relationships leading to the increase in commitment, common values, solving conflicts, stability and intimacy in marital relationship. c. Family coherence and integrity, family stability, safety and satisfaction and common goals.
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d. Social, spiritual and material support, positive role models in society and formation of deep, intimate and stable relationships between religious brothers. The researchers interested in studying this field should pay attention to the following points: (1) Most of the conducted studies have been done on the relationship between family performances and religion in foreign countries, the religious beliefs and cultures of which are different from ours and the examples mainly include the white who believe in different sects of Christianity; therefore, the results of these studies cannot be generalized to our religious traditions and cultures; in other words, studying the effect of religion on family outcomes and performances is related to culture, ethnicity, race and even gender of people and also historical, social and cultural context. (2) Researchers have to use complex statistical analyses like structural equation modeling and hierarchical regression model to study the effect of religion because the effect of religious practices and beliefs on family outcomes can be direct or indirect. (3) Although qualitative studies have made a distinction between spirituality and religion, this distinction has been forgotten and completely ignored in most experimental studies on spirituality and religion. Therefore, it is necessary for the future studies to design methods and tools for measuring spirituality as a concept which is distinct from religion. (4) Although some aspects of religion and spiritual and religious knowledge and experiences are explicit and verbal, many aspects of spiritual-religious knowledge and experiences are tacit, which is not transferrable by words. Thus, some valid tools should be designed to measure both of these aspects and investigate their separate effects.
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About the authors Mohammad Khodayarifard, Ph.D., Professor Post Doctorate of Psychotherapy and Child Clinical Psychologist Faculty of Psychology and Education, University of Tehran, Jalale Ale Ahmad Ave. Chamran Highway, 14454, Tehran, Iran E-mail: [email protected] Gholam Ali Afrooz, Ph.D. Professor Dean of Faculty of Psychology and Education, University of Tehran (President of Psychology and Counseling Organization of I.R. Iran) E-mail: [email protected]
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Sayyed Mohsen Fatemi, Ph.D. Post Doctorate, Teaching Fellow, Harvard University, Department of Psychology Lecturer in Education, Psychology and Communication, Department of Educational Studies, The University of British Columbia Email: [email protected] Yasamin Abedini Ph.D. Assistant Professor, University of Isfahan Email: [email protected]
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Mental health in intellectual/peripatetic attitude in Islamic philosophy With an emphasis on ideas by Ibn Miskawayh: Strangification of the doctrine of the mean? Saeid Zarghami-Hamrah (Kharazmi University)
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Abstract This study examines the concept of mental health in the intellectual/peripatetic approach of Islamic philosophy with regard to the ideas by Ibn Miskawayh, one of the Iranian philosophers of ethnics. Accordingly, this study assumes that Ibn Miskawayh achieved a somehow particular viewpoint toward the doctrine of the mean in Islamic culture through strangification of the doctrine. This study uses a comparative analysis of ideas by philosophers in Islamic intellectual tradition, particularly Ibn Miskawayh, regarding the Aristotle’s ideas as well as strangification. The findings indicate that in intellectual/peripatetic approach, the concept of mental health has an ethnical nature and ethics is inextricably linked to the religion. According to the linguistic, ontological, and pragmatic strangification, the process of improving mental health and treating the mental diseases are in fact Tahdhib Al-Alakhlaq (refinement of character) with the aim of achieving redemption and hereafter reward. In taking this path it is critical to know the nature of human psyche and its triple parts or faculties including Intellect, emotive and appetite as the basic knowledge. Furthermore, the criterion for growing each of mentioned powers to attain wisdom, self-restraint, and courage and finally the just human being or a person with mental health is the doctrine of the mean. As the results show, there are some differences in ideas by Ibn Miskawayh and following him Nasir al-Din Tusi with Aristotle. In the process of strangification, these two Islamic philosophers generalize the doctrine of the mean of the
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moral virtues that is concerned with feelings and desires, to Wisdom that is not rooted in feelings and desires. Therefore, they ignore the differences between intellectual and moral virtue. As a result, any theorizing regarding the medical field and health according to the formal similarities among the cultures and without focusing on the differences among them is impossible and wrong and could be considered as a type of reductionism.
Key Words Mental health, Doctrine of the mean, Peripatetic attitude, Strangification.
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1
Introduction
The discussions around the encounter between soul and body mainly started with Socrates and Plato. In an attempt to prove the immortality of the soul, Plato (2010) talks about two distinct worlds or realms: the visible or material world that is constantly changing; and the invisible or intelligible world that is unchanging and eternal but is understandable. He believes that soul is also spiritual and has a nature such as subject; hence it encounters the body that is material and changeable. The dichotomy of soul and body is supported by Aristotle in other ways. Aristotle (1966) proposes that the soul is the form of the natural body that shapes the disordered matter into a unity. Unlike Plato, Aristotle does not take soul as spiritual, but places the soul in the natural realm; the nature that is alive, dynamic, moves toward perfection, and is unceasingly changing. Accordingly, Aristotle (2011) introduces perfection or happiness as the ultimate goal of all human actions and attempts; consequently, he aims to answer the question: what is the human good? In his ideas, what is called good, is either related to the body or soul, or is irrelevant to these two and locates out of these two realms. The well-being or bodily health is one of the obvious examples of good for body, knowledge and moral virtues are the goodness for soul, and wealth is locates out of body and soul. But, the major point to be mentioned is that although the advantages such as bodily health and wealth are favorable for living with happiness, the ultimate and real goal, or happiness, is relevant to soul.
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Mental health in intellectual/peripatetic attitude in Islamic philosophy
Along the same vein, as Aristotle (2011) suggests, the exceptional feature of human soul is intellect that separates human being from other creatures. In this way, happiness means to exercise of reason or, in other words, is the intellectual life. This kind of life rather conforms to virtues. Taking an analytical standpoint, he divides virtues (arête) into two parts: intellectual virtues and moral virtues. The concept of intellectual virtue is in fact the abovementioned exercise of reason and is developed through education. But, the moral virtues involve qualifications that are concerned with feelings and desires and are developed through practice and habits. The attitude of Aristotle on moral virtues is known as the doctrine of the mean (Sherman, 1999). As he holds, when feelings and desires lead human being to extremes, it results in vices. On the other hand, when human being takes the moderation path through intellect and avoids extremes, he develops the virtues inside himself. Therefore, it could be said that virtues locate at the middle of a continuum with excess and indulgence or shortcoming as the extremes. For instance, courage is a virtue with audacity as excess and fear as indulgence locating on the two ends as vices. As another example, we could mention self-restraint as a virtue with sensualism or pleasure-seeking and suppression of tendencies as the two vices on the extremes. In addition to the virtues of courage, and self-restraint, Aristotle (2011) talks about other moral virtues such as liberality, friendliness, generousness, and specially justice and remarks on the vices for each of them. The ideas and thoughts of Aristotle in various fields, including ethics, have provided numerous Islamic philosophers through the history of Islamic philosophy with inspiration (Bashir, 2011). His ideas have had a considerable influence on Islamic philosophy so that one of the two major branches of Islamic philosophy is named after him as the mashsha’ii(peripatetic154) among whose ranks can be counted Al-Farabi, Avicenna and Averroes along with many others (Groff, 2007). On the other hand, in one other classification, one of the Islamic schools of thought is called intellectual that is to somewhat inspired by the ancient Greek philosophy and especially by the Aristotle’s philosophy. One of the influential thinkers of intellectual/peripatetic attitude is Abu ‘Ali Ahmad Ibn Muhammad Ibn Ya’qub Ibn Miskawayh, also known as Ibn 154
The school of Aristotle was called peripatetic (going from one place to another) since he used to teach his students while walking. Sometimes, his logical method is interpreted as step by step movement of thoughts.
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Miskawayh (932-1030) was a prominent Persian philosopher and historian from Ray, Iran. He was active during the Buwayhid era. His influence on Islamic philosophy is primarily on in the area of ethics. He was the author of the first major Islamic work on philosophical ethics, entitled Tadhib Al-Akhlaq (Refinement of Character), focusing on practical ethics, conduct, and refinement of character. As Miller, Vandome and John (2010) argue, he separated personal ethics from the public realm, and contrasted the liberating nature of reason with the deception and temptation of nature. The present study aims to investigate the ideas of Ibn Miskawayh on mental health in comparison with the Aristotle’s ideas.
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2
Method
This study employs comparative analysis and strangification as the method of investigation. As Rihoux (2006) believes, comparative analysis is a comparison between subjects, predicates, collections, individuals, groups or time periods which reveals the similarities and differences between them. The main part of comparative analysis is called “constant comparative analysis” and it is said that”… It involves taking one entity or piece of data, such as a statement, an interview, or a theme, and comparing it with others to identify similarities or differences. By isolating these aspects, it is then possible to develop a conceptual model of the possible relations between various entities” (Given, 2008, p. 100). In the present study, after explaining and probing the ideas of intellectual/peripatetic thinkers, particularly Ibn Miskawayh, about psyche (mind), mental disease, and mental health, these ideas are analytically compared to those of Aristotle on the same subject. This is done with the aim of identifying the manner of strangification of the doctrine of the mean in Islamic intellectual/peripatetic tradition. Strangification is defined as a set of guidelines that goal at transmitting a system of predicates of a micro-world from the original context to another context as well as judging about these system out of this other context. Therefore, strangification includes the processes such as translation, transmission and interpretation of predicates and so it is a consideration of the tacit presumptions and suppositions of a system of predicates (Wallner, 1995). Wallner talks about three types of linguistic, ontological, and pragmatic strangification (1995, pp 67-68): The linguistic strangification includes the process of decontextualizing the predicates from their original background so that they become absurd. This type 336
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Mental health in intellectual/peripatetic attitude in Islamic philosophy
of strangification provides a ground for revealing the implicit presumptions and suppositions as well as the range of application for a system of predicates or specific micro-world. The second type of strangification, ontological strangification, includes application of a system or a set of methods for a scientific discipline to another different discipline. This type of strangification clarifies the range of application and methods as well as the ontological, methodological, or epistemological limitations of a discipline. The purpose for the third type of strangification, pragmatic strangification, is offering clarification and explanation for organizational and social grounds of scientists’ activities. It creates the opportunity for analysis and illumination of organizational and social activities of scientists through scientific modification of the organizational and social grounds for these activities. Therefore, the process of strangification provides opportunities for thinkers to understand the linguistic, ontological and pragmatic assumptions and limitations of their own micro-worlds by putting their predicates under the conditions of other micro-worlds. This process indirectly allows self-reflection about the borders of a specific discipline for the scientists that are studying that particular discipline. In order to explain the nature of indirect thinking in the process of strangification, Slunecko (in Wallner & Jandl, 2006) compares it to an individual who travels abroad. This person might not communicate with the native people of the other country very well due to their different language. Even the local people might ignore him totally. This exposure to failure in communication leads to the revelation of some presumptions and behaviors that he was committed to for a successful communication in his own country.
3
Nature of psyche and its relation to happiness in intellectual/peripatetic attitude
As Corbin (1993) also indicates, in a brief overview, the development of philosophy in Islamic world has established two main branches, of course not limited to them, as Mashsha’ii(peripatetic), inspired by Aristotle, and Ishraqi(light), influenced by Hermes, Zoroaster, ancient Iranian prophet, and Plato and with the aim of restorating the reason of ancient Iran. These two main classifications were later integrated with mysticism and, Ilm al-Kalam (theology) by Mulla Sadra that led to a novel movement.
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Some of the leading representatives of peripatetic movement include Avicenna, as the most leading character in this field, Al-kindi, Al-Farabi, Averroes, and Ibn Miskawayh. Even though, these thinkers are mainly inspires by Aristotle, most of their thoughts and ideas are Neo-Platonic and among these thinkers Averroes remained faithful to Aristotle’s ideas more than the others. The other significant point to be raised is that in examining the history of Islamic philosophy other ideas and movements could be identified including Sufism, and Theology (Ilm al-Kalam). Each of these schools has played a role in the evolution and development of other intellectual and philosophical trends. As an example, the origination and evolution of peripatetic school of thought in Islamic philosophy is considered as a response to other intellectual currents that assumed thinking and philosophizing in a Greek manner to be wrong and contradictory to the Islamic teachings. From this point of view, the peripatetic current with a rational nature that is in contradiction with Sufism (theology). They claim, Quran and the prophetic tradition of prophet Mohammad are comprehensive and include the knowledge and awareness that human being needs for evolution(Esposito, 2003). Taking this viewpoint, and as Al-Shafi’i one of the figures in the current states, the manners and extents of using intellect for understanding Quran and prophetic tradition are as follows(Mohammad Javad Reza, 1418/1997): (1) Some of the issues are clearly discussed in Quran so that there is no need for further intellectual interpretations and explanations. (2) Some of the issues are implicitly stated; hence they need to be interpreted that is done according to the prophetic tradition. (3) Some of the issues are discussed in general terms and the details are left to the prophet. (4) Although Quran avoids mentioning some of the issues, the followers should refer to prophetic tradition; since Quran requires the Muslims to obey the prophet. (5) Finally, there are some issues that God has necessitated Muslims to understand them through Ijtihad (making decision according to the Islamic law). This is achieved through knowing Arabic language and representing relevant content as well as deduction as the method. Al-Ghazali, as one of the most eminent figures of Islamic theology attitude, vigorously opposed the Greek wisdom and philosophy so that he wrote a book entitled Tahafut al-falasifa (The Incoherence of the Philosophers) in which he doomed philosophers to excommunication. But, according to the points men338
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Mental health in intellectual/peripatetic attitude in Islamic philosophy
tioned from Al-Shafi’i, Al-Ghazali was well-aware of the significance of Aristotelian logic and deduction in Ijtihad and believed they are permissible and necessary (Griffel, 2009). It is worth mentioning that Averroes, as one of the leading figures in intellectual school of thought, wrote a book entitled “Tahafut al-tahafut” (The Incoherence of the Incoherence), in response to The Incoherence of the Philosophers. In this book, he doomed Al-Ghazali, the author, to excommunication (Nasr & Leaman, 1996). After presenting a brief review over the Islamic philosophical currents and explaining their disagreements and interactions, now we turn to mental health and illnesses, their natures, characteristics, and relations to human happiness from the intellectual/ peripatetic point of view. In intellectual/peripatetic attitude and following Plato, the soul or psyche is a substance that is considered independent from matter. For example, Ibn Miskawayh believes that soul, human self or psyche is totally non-material. In an attempt to prove the non-material nature of psyche, or intellect faculty, he in his major book Refinement of Character applied Aristotelian analytical/argumentative method to mention seven reasons such as: soul and the spiritual qualities are different from body and the physical qualities. Another justification offered is that the images that are created in the psyche, mind or intellect faculty could be simultaneous and pluralistic, while the emergence of several images is not possible in the field of material and body. Finally, one of the other reasons for non-material nature of psyche or the intellect faculty is that the soul is capable of understanding meanings. Although this type of understanding is rooted in experiences and materials, understanding the meanings necessitates the forces beyond the bodily and material forces. As Ibn Miskawayh believes, these forces are more superior and prominent than the bodily and material ones (2003, p. 13). Consequently, Nasir al-Din al-Tusi, one of the pioneering intellectual/peripatetic philosophers (Ezzati, 2002) along with Ibn Miskawayh, in his book Akhlaq-e-Nasiri (Nasiri Ethics), claims that human psyche is independent from material and adds that this unique human feature distinguishes and singularizes human being from other beings. He defines human morals, virtues, and happiness according to the psyche. In other words, human happiness depends upon applying and perfecting the unique human abilities, that is the mental abilities. This process is in fact the process of leading the moral life and philosophy as well as human being creation aim to guide human being in taking this path in the life. As Nasir al-Din al-Tusi indicates, achieving the mentioned goal that is
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happiness and moral life requires some principles including knowing the soul or psyche and its powers. Ibn Miskawayh (2003), following Plato’s tripartite theory of soul, argues that human soul has three separate parts or faculties: a) the intellect faculty that is the thinking power in human being which is capable of thinking, reflecting and distinguishing between good and bad; b) the emotive faculty, that on the one hand allows human being to take actions for great works and, on the other hand, dominating others; c) the appetite faculty that is the basis for human desires such as food, clothes, and sexual orientation or excess. The point that Ibn Miskawayh (Marcotte, 1992) underscores is that these three faculties are in opposition to and even hostile to each other so that each faculty seeks domination over the others. He adds that the dominant force might harm and even neutralize the other forces. It is worth pointing out that inappropriate education and internalization of habits could provide the grounds for the domination of one force more than the mentioned conditions. On the one hand, the coordination of these three forces would lead to human happiness, and the absence and lack of this coordination would cause misery. The coordination or the harmony of the three forces means that each force works in a well-adjusted and balanced manner. In other words, each does its proper thing and is far away from overpowering other forces. Human happiness, on the other hand, depends on moderately employing intellect as one of the human mental faculties as a means to direct and harmonize the mental faculties. The result of drawing on intellect is known as Hikmat (knowledge) and is defined in two types following Aristotle ideas (Corbin, 1993): on the one side, Hikmat is considered as the knowledge toward the existence and specially the fact of God’s existence who has created the universe as well as human mind; on the other side, Hikmat involves the knowledge of distinguishing between good and bad, managing and organizing the life and conducting the deeds. Therefore, as the Islamic thinkers inspired by Greek philosophers suggest, two types of Hikmat could be defined – theoretical and practical. The theoretical Hikmat involves the theology, mathematics and natural science and the practical Hikmat also includes ethics, housekeeping or economy, and politics (Surhone; Timpledon; Marseken, 2010). In this manner, Hikmat stems from developing and growing the supreme aspect of psyche or mind, the intellect faculty. The point that is specifically highlighted by Ibn Miskawayh (2003) is that Hikmat arises from the balanced evolution of the intellect faculty. In other words, achieving Hikmat requires main340
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taining a balance in exercising wisdom and staying in the middle of the continuum with Bilahat (irrationality) at one extreme or shortcoming, and Siphahat (deception and fraud) at the other extreme or excess. Here, deception could be defined as using the thinking power inappropriately and for disadvantageous goals. If human intellect faculty is dominated and overwhelmed by other mental forces or it is merely applied for material and everyday purposes including fraud and deception, then the human wisdom is used beyond the morals and in an erroneous manner. But, it should be underlined that Ibn Miskawayh does not add more explanation regarding this issue. Alternatively, irrationality also means abandoning wisdom and thinking consciously and intentionally. Following these ideas, Ibn Miskawayh (2003) introduces six representations of wisdom and knowledge and defines at the middle of a continuum with two excess and shortcoming ends. As an example, Zikr (recollecting) is at the middle of forgetfulness and mindfulness. Here, being mindful about some thoughts is considered as excess since constantly recalling them is unnecessary and would lead to turmoil in human mind and thoughts. As another example, “understanding” is the middle point of fantasizing and delayed understanding. Fantasizing means excessive use of information for the sake of mindless imaginations. Also, Impatience and hurry in acquiring knowledge is another example of excessive and incorrect application of mental qualities. As the thinkers adopting the intellectual/peripatetic attitude believe, along with the development of the most superior mental force, human being could benefit from maturing other mental forces of emotive as well as appetite faculty and these benefits are positioned between two excess and shortcoming ends (for example see: Surhone; Timpledon; Marseken, 2010). For example, self-restraint, resulting from maturing the desires, is located between sensualism and suppression of tendencies. Ibn Miskawayh (2003) proposes that intellect as well as Islamic law (Sharia) serve as the criteria for distinguishing between self-restraint and suppression. He names twelve signs for self-restraint including generosity, liberty, contentment, discipline, and, dignity. On the other hand, courage resulting from developing the emotive faculty is located between audacity and fear. In this case also Ibn Miskawayh (2003) introduces intellect and Islamic law as the criteria for distinguishing between actions representing audacity and courage. For example, if someone takes a dangerous action without thinking and irrespective of the Islamic law teachings, he would not be considered as courageous but audacious. Here, one more time Ibn
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Miskawayh mentions the nine qualities of a courageous person including ambition, patience, stability, peace, dignity, dare, and enduring hardship. Finally, the coordination of three virtues including knowledge, self-restraint, and courage would lead to the development of another virtue; justice (Ibn Miskawayh; Caetani, 2010). As the characteristics of a just person we can mention honesty, affection, friendship, devotion, kindness, pity, and leaving hatred. In conclusion, Ibn Miskawayh adds that justice is a virtue that locates between two ends of injustice and accepting injustice. According to the points, and as Marcotte (2011) argues, Ibn Miskawayh, does not follow the Aristotelian tradition in its view that happiness is only a human achievement and not identified with God or with a divine gift. Ibn Miskawayh prefers to keep within the purview of his conception of happiness both worldly types of happiness (human beings’ various ends and capabilities) and, just as important, otherworldly types of happiness for deserving souls that achieve “everlasting life and eternal happiness, by which there will fall to his happy lot to be near to the Glorious and Supreme Truth” (p. 102). A relationship exists between absolute perfection and happiness and the First One, or God, He believes. Ibn Miskawayh defines happiness in terms of one's proximity to, or distance from God: happiness is equated with proximity, whereas misery is equated with distance and alienation from God (and contamination of the rational soul). (p.103). To achieve such happiness, one can be assisted by religious guidance embodied in an ethical life that adherence to the Islamic law (Sharia), the examples of the prophets, and belief in God guarantee. (p. 104).
4
Mental Illnesses and health from intellectual/peripatetic viewpoint
According to the points raised about the relationship between maturing the psyche and human happiness in intellectual/peripatetic attitude, particularly Ibn Miskawayh ideas, now the mental illnesses and treatments are discussed with regard to the mentioned viewpoint. Following the above mentioned issues, it could be said that mental health is maintained through sustaining a balance in soul faculties since mental illnesses follow from imbalances and lack of coordination among the soul faculties and forces. Regarding the same point Ibn Miskawayh indicates the manners for preserving the mental health (2003): first, it is essential for human beings to stay on the moderation path in various life situations. Second, it is necessary to keep 342
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away from those not adhering to the moral virtues. Third, it is of high importance to undertake the best endeavor for acquiring knowledge and not to have pride and material motivations in this process. Ibn Miskawayh believes that the superior motivation to have is knowing and approaching God. Another idea is that human being should be prepared to face the desires and appetites, and to show patience in dealing with them. Conclusively, human beings should identify flaws and faults of their own souls in order to eliminate them. Afterward, Ibn Miskawayh discusses the flaws and faults of the soul, or mental illnesses, and proposes some treatments to manage them. The mental health is rooted in keeping balance and moderation and adhering to the four main virtues in life knowledge, courage, self-restraint, and justice. As an outcome, mental illnesses mean deviating from the moderation path and following extreme behaviors. Therefore, the immoderate ends of the continuums such as deception or irrationality; audacity or fear; sensualism or suppression; and cruelty and accepting injustice are all categorized under the umbrella term mental illnesses according to the intellectual/peripatetic ideas. For further clarification, Ibn Miskawayh (2003) argues about various aspects of the emotive faculty and the relevant illnesses as well as the treatments. He holds that factors such as arrogance, pointless pride, contention, obstinacy, indulgence in humor, mockery, deceit, injustice and envy could stimulate the emotive faculty of the soul. Although these features and qualities pertain to overindulgence in emotive faculty, the total abandonment of using this faculty causes another mental illness, namely fear. The reasons for fear are sometimes issues with no external realities and are merely generated by the mind of the phobic person. For example, many of the everyday human fears fall in this category. But, sometimes this condition originates from real life fears, particularly “death”. Inspired by the Plato and Aristotle ideas as well as the Islamic thoughts, Ibn Miskawayh suggests using wisdom as well as belief (Marcotte, 2011), to perceive the nature and reality of death as a treatment to cope this problem. Accordingly, in order to face this problem it is helpful to understand that death is not the end of life, but rather a passage from material and unstable universe to the everlasting and real one.
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5
Strangification of the doctrine of the mean: a different approach toward mental health?
On the basis of the discussion presented, now the ideas of intellectual / peripatetic thinkers regarding mental health and illnesses are compared to those of Aristotle. It seems the theory of these thinkers is, in some ways, strangification (Wallner, 1998) of the doctrine of the mean in Islamic culture with some modifications and improvements as follow: First, the intellectual/peripatetic thinkers interpret and redefine the doctrine of the mean in the field of Islamic literature, through linguistic strangification. From this point of view, several concepts related to mental health and illnesses, such as Aql (intellect), Ghazab (rage), Zikr (recollection), Ajul (impatient), sabr (patience), hor (free), rizayat (contentment), Ibadat (devotion), adl (justice), and Zolm (injustice) and many other concepts are taken from Quran and other Islamic texts (for example see: Sura 2, v. 44; Sura 3, v. 112; Sura 4, v. 11; Sura 17, v. 11; Sura 6, v. 24; Sura 8, v. 34; Sura 9, v. 38; Sura 10, v. 29; Sura 16, v. 76; and Sura 18, v. 15). Second, from an intellectual/peripatetic viewpoint and through using the ontological strangification, the concept of mental health takes on a moral nature and, the same as other concepts in Islamic philosophy, it is defined in relation to the religion (Halstead, 2007). Therefore, the process of tearing mental illnesses as well as maintaining the mental health sound the same as the process of refinement of character with the purpose of achieving happiness, hereafter rewards, and approaching God. Therefore and as Marcotte (2011) argues, Ibn Miskawayh does not leave or even whitewash elements of religious tradition, but rather provides them with an essential edifying role via its moral teachings, its religious Law (Shriah) and the examples of the prophets. Guidance in the form of religious instruction, law and morality can become an excellent foundation for, and complement to philosophical ethical instruction whose principles Ibn Miskawayh expounds in great details in his Tahdhib al-Akhlaq. Nevertheless, going through this process requires the preliminary and necessary knowledge of human soul and the triple forces including intellect, emotive, and appetite faculties. And the criteria for developing these soul faculties are the doctrine of the mean. In this way, the ideas of Ibn Miskawayh and Nasir al-Din al-Tusi regarding the human morals and happiness resemble the Aristotle’s thoughts presented in 344
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the first chapter of his best-known book; Nichomachean Ethics (2011). But, they gradually detach from Aristotle through their ontological strangification of discussions on goals and virtues as well as the closing discussions on the treatments for mental illnesses by eliminating the vices. It is worth stating that, in the ending parts of his book Nichomachean Ethics, Aristotle starts the initial discussions on the politics. As the final point, Ibn Miskawayh and Nasir al-Din al-Tusi ignore the differences that Aristotle underlines between intellectual and moral virtues by pragmatic strangification of the doctrine of the mean. Aristotle (2011) believes that the moral virtues involve appetites and desires and only if they follow mediation, they would be considered as virtues. The virtues such as courage, self-restraint, and justice fall into this category. Form Aristotle’s point of view, justice is the most superior virtue among others that locates between injustice and accepting injustice. The theoretical virtues are not rooted in appetites and desires but thoughts. Aristotle does not remark on mediation, rather he believes that knowledge is a type of theoretical virtue with no limit and the more human makes progress in this path, the more happier he would be. Accordingly, Aristotle introduces knowledge, not justice, as the most superior virtue in the fields of theoretical virtues as well as moral virtues. The differences between Ibn Miskawayh and after him Nasir al-Din al-Tusi with Aristotle ideas rest in fact that, throughout the process of pragmatic strangification of the doctrine of the mean, these two thinkers apply this approach to all virtues and theoretical virtues. Therefore, they take theoretical virtues, which are not based on appetites and desires, as moral virtues only if they follow the mediation criterion. For example, for them, knowledge is defined on a continuum between irrationality and deception. Ignoring the differences between theoretical virtues and moral virtues by Ibn Miskawayh and after him Nasir al-Din al-Tusi could be attributed to lack of awareness and accessibility to Aristotle’s works. Supporting the mentioned reason, Naghibzadeh (2007) states that as a result Ibn Miskawayh and after him Nasir al-Din al-Tusi sometimes take knowledge as the most superior virtue and other times justice. But, I think there is another reason for overlooking the differences between theoretical virtues and moral virtues by these two thinkers. Inspired by their Islamic beliefs, they relate knowledge with morals and religion. For example, using thinking power for deceptive purposes is considered as immoral in Islamic teachings, therefore they reject excessive use of wisdom for immoral and non
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religion purposes and define knowledge as the middle point between immoral and non-religious irrationality and deception.
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6
Concluding remarks
The present study examined the concept of “mental health and illnesses” from an intellectual/peripatetic standpoint in Islamic philosophy with an emphasis on the ideas of Iranian-Islamic philosopher of ethics, Ibn Miskawayh. The findings of this study revealed that Ibn Miskawayh attained a rather specific attitude toward Aristotle theory of the mean in Islamic culture through strangification of this theory. This attitude proposes a different framework for understanding mental illnesses as well as the treatments that is based on the relationships among wisdom, religion, and morals and the coordination of these factors for mental health and illnesses. As it seems, in this conference the papers mainly covered three subjects. It’s worth mentioning that such categorization is relative and some overlapping points or differences may have been ignored. First, one category of papers addressed theoretical and sometimes practical issues about health and illnesses from the viewpoint of one of the four cultures. For example, the papers by Dr. Chaiyasuj, Dr. Lopez Cerezo, Dr. Sirikanchana, Dr. Mahanarongchai, Dr. Jianguo, Dr. Lishan, Dr. Khalili, and Dr. Khodayarifard could be included in this category. For instance Dr. Chaiyasuj introduced the basic concepts as well as the principles of Thai Traditional Medicine. Dr. Lopez Cerezo also believed the anatomical-pathological revolution in early nineteenth century is the origion of modern western medicine the revolution led to the objectivization of medical expertise & the most founder of the trend is Rene Laennec. Dr. Sirikanchana explained Buddhist teachings clearly and simply. In this regard the focal idea of Dr. Mahanarongchai was that life is the cyclical flow of vital life-force with twelve interweaving links and health is the capacity of self-generation which keeps each of life-forces vital and active. On the other hand Dr Jianguo tried to elaborate on the Traditional Chinese Medicine as the most extraordinary and complex Asian medical system. Dr. Lishan also mentioned that Traditional Chinese Medicine is characterized by its focus on the whole person as a unique individual and also focus on the treatment of the underlying causes not symptoms of illnesses. But Dr. Khalili believed that the history of civilization is an evolutionary history and so for instance today's medicine is better than the old one. One 346
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of the challenging implications of such idea is that due to belonging the medical systems of nonwestern cultures to the past, they will be old and so weak and inefficient. On the other hand modern western medicine will be strong and efficient. Finally Dr. Khodayarifard started with some “what” and “why” types of discussion about spiritual-religion family therapy and followed up with some “who” types of discussion in this regard. Second, the other category, by adapting a meta-theoretical viewpoint, offered different criteria or approaches for establishing dialogue and making the viewpoints of various cultures more understandable regarding the subject of health and illness. The papers such as professor Wallner and professor Lan paper, Mr. Schulz paper, and Dr. Edlinger paper could be placed in this category. For instance one of the explicit result of the professor Wallner and professor Lan paper is that each of us due to our different cultures need to understand the other cultures by using strangification strategy and as they have shown well, understanding means to know the conditions of a culture. In this regard Mr. Schulz argued that different medical systems depend on the presuppositions of different cultures and so we can’t favor one of these different medical systems on the basis of rational arguments. Finally Dr. Edlinger referred Fleck proposes the concept of Denk collective. This concept helps explain how scientific ideas change over timesimilar to Thomas Kuhn’s notion of paradigm shift or Foucault’s episteme. Fleck claims that the development of truth in scientific research is an unattainable ideal as different researchers are locked in thought collectives. He believes that the development of scientific insights was not unidirectional and does not consist of just accumulating new pieces of information, but also in overthrowing the old ones. This approach anticipated later development in social constructivism and specially the development of critical science and technology studies. Third, another category applied the mentioned criteria and approaches to compare the standpoints of different cultures concerning health and illnesses. The papers like Mr. Bagheri paper, Dr. Holzenthal paper, Dr. Hashi paper and mine might be included in this category. For Instance and as one of implicit results of Mr. Bagheri paper, we see some contradictory views not only in two different cultures, for example between Islamic and western cultures, but also in a special culture through different and sometimes opposite views in Islamic culture, I mean between Hallaj and Theologists who accused Hallaj of excommunication. On the other hand Dr. Holzenthal, after asking the question that “what is the relationship between Culture and Medicine?”, answered that Constructive
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Realism emphasizes that Medicine depends profoundly on cultural presuppositions. Finally Dr. Hashi, after explaining Dr. Morita’s psychophysical Therapy and the way it is influenced by Zen Buddhism, Mentioned modern medicine is not the best method of treatment for some psycho-physical problems. As the conclusion drawn from the discussions presented in the conference, the following points are offered: First, as Professor Wallner highlights, the dialogue among different cultures in various fields, including medicine, could be achieved based on the criterion of understanding, not plausibility. The potential reason is that the concept of plausibility has been formed and introduced as a criterion in the western context. Professor Wallner and professor Lan propose some approaches and methods for understanding different cultural views regarding health and illness. The second point to be mentioned is related to the encounters and interactions among the cultures. In this way we see some contradictory views not only in two different cultures (for instance between chiness and western cultures) but also in a special culture through different and sometimes opposite views in a culture for instance between Hallaj & the theologists who accused Hallaj of excommunication. On the other hand & for instance we could mention the interactions among main ancient cultures on the subject of physical or mental health. For example, discussing the four or five elements or the material and supernatural factors for the subject of health and illness is an indication of interactions among various cultures in this field. Of course some researchers may believe that comparing the five elements with the western system of the four elements would be wrong. Whereas the classical Greek elements were concerned with substances or natural qualities, the Chinese five elements are “primarily concerned with process and chang”. Although such argumentation sounds plausible anyway we can’t ignore the interactions between these cultures on the same issue. Let me explain more. For instance in addition to the four elements that are natural qualities, Greek natural philosophers also talked about the other factors such as logos and nous with nonmaterial nature. On the other hand and whereas Parmenides referred to stability, Heraclitus emphasized on process and change. And I think Heraclitus’ Idea, let call it as the process metaphysics (Goldman, 2007), since the mid 19th century till the present becomes increasingly important & a source of many of the most new scientific ideas. The ideas such as “energ”, “fields” and even “the theory of relativity” in physics and “the evolution theory” in biology have emerged on the basis of Heraclitus metaphysics not Parmenides metaphysics. 348
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The other ground involves interactions among different cultures regarding the objective view toward health and illness. For example, Galen and Avicenna who were from different cultures used dissecting the bodies, which is considered as an objective method in medicine in order to find the reasons for illnesses. This method is common today and is largely applied in the field of medicine. But, clearly the objective view is largely used in the field of modern medicine recently more than ever with the help of technological innovations. Nowadays, this objective view has affected medicine in other cultures. For example, in the Iranian culture the effectiveness of herbal medicine is explained according to the objective criteria such as the effects of herbal medicine on chemical and biological mechanisms. But the point to be mentioned is that in the process of interactions among the cultures each culture defines and interprets other cultures according to its own specific ground and context. The reason is rooted in the different and specific assumptions and presumptions that each culture maintains. In this process, each culture seek for similarities as the basis for transferring elements, principles, laws, characteristics or things like that from one culture to another and find applications for that in the destination culture. The important point that should be taken into account here is that these elements, principles, laws, characteristics take on a new sense by entering the new culture and are defined and used in relation to other elements in that given culture. In this way, the new senses might be different from, and even in conflict with, those of the original culture. As an example we could refer to the ethics theory by Miskawayh in Islamic philosophy that is derived from Aristotle’s mean theory. Therefore, focusing on the similarities in comparing two mentioned cultures might lead to ignoring many fundamental differences in the presumptions and assumptions in the cultures. For understanding these presumptions and assumptions, Wallner suggests a method called strangification. He believes that strangificaion and comparison are necessary for avoiding the meta-theories in the process of understanding the cultures but he emphasizes that in the process of strangification the focus should be on differences rather than the similarities. Because, as it was explained, in the process of interaction among the cultures and the concepts are transferred from one culture to another, they are defined and applied in the new ground and context. In this way, understanding on the one hand requires comparing the cultures and on the other hand attending to the differences of the cultures. This is true about the health and illness concepts. In other words, for understanding the concept of health and illness in a culture we could find out about the presump-
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tions and assumptions by strngification of these concepts. Therefore, it seems that the concepts of health and illness, like other concepts, takes on different senses in various cultures. Overlooking these differences means ignoring the differences in presumptions and assumptions of the cultures and offering wrong pictures of them. As a result, any theorizing regarding the medical field and health according to the formal similarities among the cultures and without focusing on the differences among them is impossible and wrong and could be considered as a type of reductionism. As the final point, and following the above-mentioned points, regarding mental health, it seems that leading a balanced life is one of the fundamental criteria of the four cultures in the discussions of health in spite of the numerous differences. As an example, Buddha believes that life means “suffering” because the nature of life is craving and clinging. Consequently, he believes that in order for human being to get rid of this condition, he should understand this situation, reduce the cravings and balance them with other forces in the world. On the same issue, Schopenhauer and Nietzsche also hold similar ideas to those of Buddha. For example, admiring the ideas of Buddha, Nietzsche calls him a great physiologist. In this way, and despite various differences, these two thinkers have many ideas in common on this subject. From another point of view, Gandhi indicates the inadequacies of the modern medicine for overlooking the soul and mental grounds and taking a reductionist and imbalanced approach. In the same way, the vitalism theory by Hans Driesch and the life philosophy by Bergson criticize the objective view toward science, including medicine, and propose a holistic and balanced approach instead. This view is also suggested and appreciated in Chinese culture. Accordingly, it seems that some of the thinkers such as Freud and Habbes also believe that a form of “balance” is necessary for mental health. For instance, Freud claims that biological needs are source of pressure and satisfying these needs reduces the pressure and leads to a kind of balance. In brief, it could be said that balance and coordination are the key factors to mental and even physical health and losing the balance and self-indulgence in any aspect, from seeking power to consumerism, would affect the calmness in a negative way; as warned by Aristotle, Miskawayh, and many other thinkers from different cultures. It is worth mentioning that this understanding would be hopefully obtained on the basis of strangification approach.
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Naghibzadeh, M, A. (2007). An Introduction to Philosophy. [Daramadi be Falsafeh]. Tehran: Tahoori. 22 Wallner, F. (1995). Constructivism and alienating inter-disciplinarily: its educational consequences. In Vincent Shen & Tran Van (Eds.). Philosophy of science and education: Chiness and European views. Washington: Library of congress cataloging- in- publication. 23 Wallner, F. (1998). A new vision of science. 20th world conference of philosophy. Boston, Massachusetts, USA. 24 Wallner, F; Jandl, M. J. (2006). The importance of constructive realism for the indigenous psychologies approach. In Uichol Kim; kuo-Shu Yang; & Kwang-Kuo Hwang (Eds.). Indigenous and cultural psychology: understanding people in context. New York: Springer science.
About the author
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Saeid Zarghami-Hamrah, Kharazmi University [email protected]
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LIBRI NIGRI DENKEN ÜBER GRENZEN
Herausgegeben von Hans Rainer Sepp
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Die libri nigri treffen sich bevorzugt an Orten, an denen die Grenzen von Wirklichkeitsbereichen, Standpunkten, Fachrichtungen sowie Kultur- und Wissenstraditionen in den Blick geraten und ihre Voraussetzungen verhandelbar werden. Begründungsabsichten nachzuspüren, gilt hier mehr, als Begründungen zu suchen, das wagende Experiment mehr als die gültige Schablone, die störende Bewegung mehr als der Drang nach Absicherung. Da die Orte für entscheidende Bewegungen meist Ränder und nicht Zentren sind und da Grenzen nicht einfach nur begrenzen, sondern vor allem Potentiale des Anderen und Fremden bergen, wird sich die Reihe auch dem Terrain des Utopischen nicht verweigern.
1
Hans Rainer Sepp Die Grenze denken Prolegomena zu einer Philosophie des Transkulturellen broschiert ISBN 978-3-88309-792-3 gebunden ISBN 978-3-88309-793-0
2
Yoshiko Oshima Zen – anders denken? Zugleich ein Versuch über Zen und Heidegger 2. Aufl. broschiert ISBN 978-3-88309-846-3 gebunden ISBN 978-3-88309-847-0
3
Max Lorenzen Philosophie der Nachmoderne Die Transformation der Kultur – Virtualität und Globalisierung Herausgegeben von Cathrin Nielsen broschiert ISBN 978-3-88309-668-8 gebunden ISBN 978-3-88309-668-1
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Hisaki Hashi und Friedrich G. Wallner (Hg.) Globalisierung des Denkens in Ost und West Resultate des Österreichisch-Japanischen Dialogs broschiert ISBN 978-3-88309-555-4 gebunden ISBN 978-3-88309-560-8
5
Aleš Novák Heideggers Bestimmung des Bösen broschiert ISBN 978-3-88309-650-6 gebunden ISBN 978-3-88309-651-3
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
6
André Julien S. E. Faict Philosophische Voraussetzungen des interkulturellen Dialogs Die vergleichende Philosophie von Hajime Nakamura im Dialog mit Anthropologie und Hermeneutik broschiert ISBN 978-3-88309-683-4 gebunden ISBN 978-3-88309-684-1
7
Peter Schwankl Diplomatisches Verhalten Ein phänomenologischer Versuch über das Wesen des Diplomatischen Herausgegeben von Georg Lechner broschiert ISBN 978-3-88309-517-2 gebunden ISBN 978-3-88309-516-5
8
Paul Janssen Vom zersprungenen Weltwerden broschiert ISBN 978-3-88309-685-8 gebunden ISBN 978-3-88309-686-5
9
Constantin Noica De dignitate Europae Übersetzt von Georg Scherg Herausgegeben von Mădălina Diaconu broschiert ISBN 978-3-88309-708-4 gebunden ISBN 978-3-88309-709-1
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Constantin Noica Briefe zur Logik des Hermes Übersetzt von Christian Ferencz-Flatz und Stefan Moosdorf broschiert ISBN 978-3-88309-434-2 gebunden ISBN 978-3-88309-435-9
11
Ananta Charan Sukla (ed.) Art and Expression Contemporary Perspectives in the Occidental and Oriental Traditions broschiert ISBN 978-3-88309-710-7 gebunden ISBN 978-3-88309-711-4
12
Dean Komel Den Nihilismus verwinden Ein slowenisches Postscript zum 20. Jahrhundert broschiert ISBN 978-3-88309-712-1 gebunden ISBN 978-3-88309-713-8
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
13
Tatiana Shchyttsova (Hg.) In statu nascendi Geborensein und intergenerative Dimension des menschlichen Miteinanderseins broschiert ISBN 978-3-88309-716-9 gebunden ISBN 978-3-88309-688-9
14
Chung-Chi Yu and Kwok-ying Lau (eds.) Phenomenology and Human Experience broschiert ISBN 978-3-88309-722-0 gebunden ISBN 978-3-88309-723-7
15
Daniel Aebli Wie modern ist die Antike? Studien und Skizzen zur Altertumswissenschaft broschiert ISBN 978-3-88309-729-9 gebunden ISBN 978-3-88309-730-5
16
Hiroo Nakamura Für den Frieden broschiert ISBN 978-3-88309-731-2 gebunden ISBN 978-3-88309-732-9
17
Günter Fröhlich Anthropologische Wege Ulmer Stadthausvorträge broschiert ISBN 978-3-88309-733-6 gebunden ISBN 978-3-88309-734-3
18
Hans-Dieter Bahr Die Anwesenheit des Gastes Entwurf einer Xenosophie broschiert ISBN 978-3-88309-761-9
19
Massimo Mezzanzanica Von Dilthey zu Levinas Wege im Zwischenbereich von Lebensphilosophie, Neukantianismus und Phänomenologie broschiert ISBN 978-3-88309-750-3
20
Klaus Kanzog Mit Auge und Ohr Studien zur komplementären Wahrnehmung broschiert ISBN 978-3-88309-784-8 gebunden ISBN 978-3-88309-785-5
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
21
Silvia Stoller und Gerhard Unterthurner (Hg.) Entgrenzungen der Phänomenologie und Hermeneutik Festschrift für Helmuth Vetter zum 70. Geburtstag broschiert ISBN 978-3-88309-771-8 gebunden ISBN 978-3-88309-772-5
22
Claus C. Schnorrenberger Chinesische Medizin – Placebo, Wissenschaft oder Wirklichkeit? broschiert ISBN 978-3-88309-776-3 gebunden ISBN 978-3-88309-777-0
23
Detlef Thiel Maßnahmen des Erscheinens Friedlaender/Mynona im Gespräch mit Schelling, Husserl, Benjamin und Derrida broschiert ISBN 978-3-88309-782-4 gebunden ISBN 978-3-88309-783-1
24
Leonidas Donskis Fifty Letters from the Troubled Modern World A Philosophical-Political Diary 2009–2012 broschiert ISBN 978-3-88309-799-2 gebunden ISBN 978-3-88309-800-5
25
Hartmut Buchner Heidegger und Japan – Japan und Heidegger Vorläufiges zum west-östlichen Gespräch broschiert ISBN 978-3-88309-836-4 gebunden ISBN 978-3-88309-837-1
26
Kateřina Šolcová Comenius im Blick Der Briefwechsel zwischen Milada Blekastad und Dmitrij Tschižewskij Deutsch-Tschechische Ausgabe broschiert ISBN 978-3-88309-843-2 gebunden ISBN 978-3-88309-844-9
27
Karin Knobel Poetik des Staubes bei Goethe und Hafis broschiert ISBN 978-3-88309-838-8 gebunden ISBN 978-3-88309-839-5
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
28
Ryôsuke Ohashi Schnittpunkte Essays zum ost-westlichen-Gespräch Erster Band: Dimensionen des Ästhetischen broschiert ISBN 978-3-88309-859-3 gebunden ISBN 978-3-88309-860-9
29
Ryôsuke Ohashi Schnittpunkte Essays zum ost-westlichen-Gespräch Zweiter Band: Deutsch-Japanische Denkwege broschiert ISBN 978-3-88309-885-2 gebunden ISBN 978-3-88309-886-9
30
Aleš Novák (Hg.) Grenzen der Transzendenz Aus dem Tschechischen übersetzt von Jana Krötzsch broschiert ISBN 978-3-88309-854-8 gebunden ISBN 978-3-88309-855-5
31
Boško Tomašević Hervorgang des Seins Das ontologische Geschehen des Dichtens broschiert ISBN 978-3-88309-952-1 gebunden ISBN 978-3-88309-953-8
32
Gerard Visser Nichts ist geschenkt Ein philosophischer Essay über die Seele Aus dem Niederländischen übersetzt von Anna Sikora broschiert ISBN 978-3-88309-871-5 gebunden ISBN 978-3-88309-872-2
33
Marcin Rebes Der Streit um die transzendentale Wahrheit Heidegger und Levinas broschiert ISBN 978-3-88309-942-2 gebunden ISBN 978-3-88309-943-9
34
Jürgen Trinks Überleben des Phänomens im Symbolischen Studien zur sprachphänomenologischen Kulturwissenschaft broschiert ISBN 978-3-88309-875-3 gebunden ISBN 978-3-88309-876-0
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
35
Martin Cajthaml Europe and the Care of the Soul Jan Patočka’s Conception of the Spiritual Foundations of Europe With a Preface by Peter McCormick broschiert ISBN 978-3-88309-887-6 gebunden ISBN 978-3-88309-888-3
36
Leonidas Donskis Das Ende von Ideologie und Utopie? Moralität und Kulturkritik im zwanzigsten Jahrhundert Aus dem Englischen übersetzt von Cathrin Nielsen broschiert ISBN 978-3-88309-883-8 gebunden ISBN 978-3-88309-884-5
37
Dean Komel Kontemplationen Entwürfe zur phänomenologischen Hermeneutik broschiert ISBN 978-3-88309-903-3 gebunden ISBN 978-3-88309-904-0
38
Armin Wildermuth Findlinge Gefundenes und Erfundenes broschiert ISBN 978-3-88309-944-6 gebunden ISBN 978-3-88309-945-3
39
Hisaki Hashi (Hg.) Denkdisziplinen von Ost und West Interdisziplinäre Philosophie in einer globalen Welt
40
Markus Ophälders Konstruktion von Erfahrung Versuch über Walter Benjamin
41
Ivan Chvatík and Lubica Ucník (eds.) Asubjective Phenomenology Jan Patočka’s Project in the Broader Context of his Work
42
Terri Jane Hennings Writing Against Aesthetic Ideology Tom Sharpe’s The Great Pursuit and Paul Auster’s City of Glass
43
Irina Hron (ed.) Thinking in Unity after Postmodernism Figures of Unity, Presence, and Transcendence at the Millennium
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.
Nicole Thiemer Zwischen Hermes und Hestia Hermeneutische Lektüren zu Heidegger und Derrida broschiert ISBN 978-3-88309-946-0 gebunden ISBN 978-3-88309-947-7
45
Sumalee Mahanarongchai Health and Disease in Buddhist Minds broschiert ISBN 978-3-88309-950-4 gebunden ISBN 978-3-88309-951-4
46
Fengli Lan and Friedrich G. Wallner (eds.) The Concepts of Health and Disease From the Viewpoint of four Cultures broschiert ISBN 978-3-88309-948-4 gebunden ISBN 978-3-88309-949-1
Copyright © 2015. Traugott Bautz Verlag. All rights reserved.
44
The Concepts of Health and Disease, edited by Fengli Lan, and Friedrich G. Wallner, Traugott Bautz Verlag, 2015.